Healthcare Provider Details

I. General information

NPI: 1982175543
Provider Name (Legal Business Name): VERNON AZUMA, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DRIVE STE 211
AIEA HI
96701
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DRIVE STE 211
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-8441
  • Fax:
Mailing address:
  • Phone: 808-488-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON M AZUMA
Title or Position: PRESIDENT
Credential: MD
Phone: 808-488-8441