1306998570 NPI number — DR. RAMONA KEIKO LEE CORSON R.PH, PHARM.D.,

Table of content: MR. RAKHMIN S. KHOSHAYEV PA-C (NPI 1780883785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306998570 NPI number — DR. RAMONA KEIKO LEE CORSON R.PH, PHARM.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORSON
Provider First Name:
RAMONA
Provider Middle Name:
KEIKO LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH, PHARM.D.,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306998570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 DAIRY ROAD
Provider Second Line Business Mailing Address:
SUITE E-143
Provider Business Mailing Address City Name:
KAHULUI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-242-4044
Provider Business Mailing Address Fax Number:
808-243-6630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 MAHALANI STREET
Provider Second Line Business Practice Location Address:
KAISER WAILUKU CLINIC
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-243-6106
Provider Business Practice Location Address Fax Number:
808-243-6630
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PH - 1115 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835P1200X , with the licence number: RPH 47849 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X , with the licence number: RP035379L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)