Healthcare Provider Details

I. General information

NPI: 1396898557
Provider Name (Legal Business Name): JOHN J COGAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 707
HONOLULU HI
96813-2434
US

IV. Provider business mailing address

PO BOX 25370
HONOLULU HI
96825-0370
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-7327
  • Fax:
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number3361
License Number StateHI

VIII. Authorized Official

Name: JOHN COGAN
Title or Position: OWNER
Credential: MD
Phone: 808-536-7327