Healthcare Provider Details

I. General information

NPI: 1801419445
Provider Name (Legal Business Name): LYNN D. MADANAY, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

347 N KUAKINI ST
HONOLULU HI
96817-2381
US

IV. Provider business mailing address

233 WAILUPE CIR
HONOLULU HI
96821-1550
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LYNN MADANAY
Title or Position: PRESIDENT
Credential:
Phone: 808-469-2210