Healthcare Provider Details

I. General information

NPI: 1437271962
Provider Name (Legal Business Name): GORDON C. ONTAI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST SUITE 201
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1329 LUSITANA ST SUITE 201
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9300
  • Fax: 808-523-8834
Mailing address:
  • Phone: 808-523-9300
  • Fax: 808-523-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GORDON C. ONTAI
Title or Position: PRES.
Credential: M.D.
Phone: 808-523-9300