Healthcare Provider Details

I. General information

NPI: 1821144403
Provider Name (Legal Business Name): RUSS RAJ ARJAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 PUUHONU WAY
HILO HI
96720-2066
US

IV. Provider business mailing address

PO BOX 4049
ALAMEDA CA
94501-0449
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-3979
  • Fax: 808-935-7657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036165353
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-23967
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00049187
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0043601
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC171402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: