Healthcare Provider Details

I. General information

NPI: 1538330147
Provider Name (Legal Business Name): DAVID JOHN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2008
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 804
HONOLULU HI
96813-2434
US

IV. Provider business mailing address

1329 LUSITANA ST STE 804
HONOLULU HI
96813-2434
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-7111
  • Fax:
Mailing address:
  • Phone: 808-531-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD3791
License Number StateHI

VIII. Authorized Official

Name: MS. SELINA MATTOS
Title or Position: BILLING SPECISLIST
Credential: CPC
Phone: 808-531-7111