Healthcare Provider Details

I. General information

NPI: 1780755397
Provider Name (Legal Business Name): MARI UEHARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1946 YOUNG ST SUITE 360
HONOLULU HI
96826-2150
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8387
  • Fax: 808-945-1570
Mailing address:
  • Phone: 808-973-7320
  • Fax: 808-973-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-10821
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD-10821
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: