Healthcare Provider Details

I. General information

NPI: 1649267063
Provider Name (Legal Business Name): THOMAS H MAEDA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST SUITE 707
HONOLULU HI
96817-2364
US

IV. Provider business mailing address

321 N KUAKINI ST SUITE 707
HONOLULU HI
96817-2364
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-2828
  • Fax:
Mailing address:
  • Phone: 808-528-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1289
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: