Healthcare Provider Details

I. General information

NPI: 1790923878
Provider Name (Legal Business Name): DONALD K. MARUYAMA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N. KUAKINI ST. STE. 814
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

321 N. KUAKINI ST. STE. 814
HONOLULU HI
96817-2362
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-0502
  • Fax: 808-545-4662
Mailing address:
  • Phone: 808-531-0502
  • Fax: 808-545-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number951
License Number StateHI

VIII. Authorized Official

Name: MR. DONALD KAY MARUYAMA SR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-531-0502