1336751643 NPI number — RACHELLE MARIE CHIEKO LAM BS OTR

Table of content: RACHELLE MARIE CHIEKO LAM BS OTR (NPI 1336751643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336751643 NPI number — RACHELLE MARIE CHIEKO LAM BS OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAM
Provider First Name:
RACHELLE
Provider Middle Name:
MARIE CHIEKO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUNADA
Provider Other First Name:
RACHELLE
Provider Other Middle Name:
MARIE CHIEKO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336751643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 S BERETANIA ST STE 730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-593-2830
Provider Business Mailing Address Fax Number:
808-593-2840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94-1030 WAIPIO UKA ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-4084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-4263
Provider Business Practice Location Address Fax Number:
808-686-9605
Provider Enumeration Date:
08/18/2020

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: 225X00000X , with the licence number:  OT135 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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