1972691590 NPI number — DR. VIJAYA V. VELLANKI M.D.

Table of content: SKYLAR JACOBSEN (NPI 1013875384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972691590 NPI number — DR. VIJAYA V. VELLANKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELLANKI
Provider First Name:
VIJAYA
Provider Middle Name:
V.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1972691590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 WARD AVE
Provider Second Line Business Mailing Address:
SUITE 840
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-522-4521
Provider Business Mailing Address Fax Number:
808-522-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 WARD AVE
Provider Second Line Business Practice Location Address:
SUITE 840
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-522-4521
Provider Business Practice Location Address Fax Number:
808-522-3526
Provider Enumeration Date:
10/10/2006

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: 2084P0800X , with the licence number:  MD-12326 , 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: 564080 02 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56408001 . This is a "ALOHA CARE - KAHI MOHALA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0251643 . This is a "HMSA - STRAUB" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 56408002 . This is a "ALOHA CARE - STRAUB" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 564080 01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 569562 . This is a "UHA - KAHI MOHALA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: MD12326 . This is a "MDX HAWAII - KAHI MOHALA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000251645 . This is a "HMSA - KAHI MOHALA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 5695444 . This is a "UHA - STRAUB" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 990298651-96706-G006 . This is a "TRICARE - KAHI MOHALA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: MD12326-01 . This is a "MDX HAWAII - STRAUB" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com