Healthcare Provider Details

I. General information

NPI: 1053177733
Provider Name (Legal Business Name): DIPANJAN BANERJEE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 709
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

2733 PUUHONUA ST
HONOLULU HI
96822-1763
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DIPANJAN BANERJEE
Title or Position: OWNER
Credential: MD
Phone: 650-533-2433