Healthcare Provider Details

I. General information

NPI: 1407968365
Provider Name (Legal Business Name): JAY M MARUMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST SUITE 750
HONOLULU HI
96814-1870
US

IV. Provider business mailing address

1401 S BERETANIA ST SUITE 750
HONOLULU HI
96814-1870
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-2261
  • Fax: 808-538-3957
Mailing address:
  • Phone: 808-536-2261
  • Fax: 808-538-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD7568
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: