Healthcare Provider Details

I. General information

NPI: 1699973503
Provider Name (Legal Business Name): JONATHAN DWORKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 KOKO HEAD AVE
HONOLULU HI
96816-3234
US

IV. Provider business mailing address

1407 KOKO HEAD AVE
HONOLULU HI
96816-3234
US

V. Phone/Fax

Practice location:
  • Phone: 917-509-5199
  • Fax:
Mailing address:
  • Phone: 917-509-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD-15131
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: