Healthcare Provider Details

I. General information

NPI: 1013006659
Provider Name (Legal Business Name): JAY L. GREKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

888 S KING ST STRAUB DEPARTMENT OF DERMATOLOGY
HONOLULU HI
96813-3009
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4360
  • Fax: 808-522-3361
Mailing address:
  • Phone: 808-522-4360
  • Fax: 808-522-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD-3643
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: