1811942584 NPI number — KATHLEEN A L OGINO DPT

Table of content: KATHLEEN A L OGINO DPT (NPI 1811942584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811942584 NPI number — KATHLEEN A L OGINO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGINO
Provider First Name:
KATHLEEN
Provider Middle Name:
A L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1811942584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92-1448 PALAHIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAPOLEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96707-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-599-0045
Provider Business Mailing Address Fax Number:
808-591-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 KAMOKILA BLVD
Provider Second Line Business Practice Location Address:
#114
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-2097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-674-0500
Provider Business Practice Location Address Fax Number:
808-674-0511
Provider Enumeration Date:
05/23/2006

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: 225100000X , with the licence number:  PT784 , 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: 567414 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C0240915 . This is a "TRIWEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 525690 . This is a "SUMMERLIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00C0240915 . This is a "HMSA BASIC,65C/65C,HMO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 204435027 . This is a "HMAA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 7848787 . This is a "UHA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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