Healthcare Provider Details

I. General information

NPI: 1982700928
Provider Name (Legal Business Name): MINA GANAPATHY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S KING ST STE 908
HONOLULU HI
96814-1953
US

IV. Provider business mailing address

820 MILILANI ST STE 702A
HONOLULU HI
96813-2918
US

V. Phone/Fax

Practice location:
  • Phone: 808-597-1999
  • Fax: 808-597-1201
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 8499
License Number StateHI

VIII. Authorized Official

Name: MINA GANAPATHY
Title or Position: MD
Credential: MD
Phone: 808-597-1999