Healthcare Provider Details

I. General information

NPI: 1346457116
Provider Name (Legal Business Name): MICHAEL PATRICK MOURI M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 LILIHA ST SUITE 207
HONOLULU HI
96817-3115
US

IV. Provider business mailing address

1744 LILIHA ST STE 207
HONOLULU HI
96817-3115
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-6073
  • Fax:
Mailing address:
  • Phone: 469-585-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number18734
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberM8095
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number18734
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18734
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM8095
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18734
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM8095
License Number StateHI
# 8
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberM8095
License Number StateHI
# 9
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number18734
License Number StateAL
# 10
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18734
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: