1811120082 NPI number — EDWARD L. CHESNE, M.D., INC.

Table of content: (NPI 1811120082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811120082 NPI number — EDWARD L. CHESNE, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD L. CHESNE, M.D., INC.
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:
1811120082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1380 LUSITANA STREET
Provider Second Line Business Mailing Address:
SUITE 1002
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-521-7402
Provider Business Mailing Address Fax Number:
808-537-2094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 LUSITANA STREET
Provider Second Line Business Practice Location Address:
SUITE 1002
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-521-7402
Provider Business Practice Location Address Fax Number:
808-537-2094
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHESNE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
LEONARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-521-7402

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD1304 , 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: 01905101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20503 . This is a "HMSA (B/C B/S OF HAWAII)" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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