1467517185 NPI number — FREDERICK A. HARADA, M.D. LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467517185 NPI number — FREDERICK A. HARADA, M.D. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK A. HARADA, M.D. LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467517185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MAILCODE 47866 BOX 1300
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:
96807-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-941-3363
Provider Business Mailing Address Fax Number:
808-949-0483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 LUSITANA ST
Provider Second Line Business Practice Location Address:
SUITE 909
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-585-7771
Provider Business Practice Location Address Fax Number:
808-585-7774
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARADA
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
808-585-7771

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  11974 , 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)

  • Identifier: 10693824 . This is a "HAWAII WITHHOLDING ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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