Healthcare Provider Details

I. General information

NPI: 1225135908
Provider Name (Legal Business Name): LYNN DEREK MADANAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST KUAKINI MEDICAL CENTER DEPARTMENT OF NUCLEAR MEDICINE
HONOLULU HI
96817-2336
US

IV. Provider business mailing address

347 N KUAKINI ST KUAKINI MEDICAL CENTER DEPARTMENT OF NUCLEAR MEDICINE
HONOLULU HI
96817-2336
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-9549
  • Fax: 808-547-9554
Mailing address:
  • Phone: 808-547-9549
  • Fax: 808-547-9554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number4768
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: