Healthcare Provider Details

I. General information

NPI: 1013911734
Provider Name (Legal Business Name): STUART SUGIHARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 502
HONOLULU HI
96817-2361
US

IV. Provider business mailing address

321 N KUAKINI ST STE 502
HONOLULU HI
96817-2361
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-9753
  • Fax: 808-531-5408
Mailing address:
  • Phone: 808-531-9753
  • Fax: 808-531-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number3866
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: