Healthcare Provider Details

I. General information

NPI: 1366648230
Provider Name (Legal Business Name): JEREMY S RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE STE 208
HONOLULU HI
96816-5312
US

IV. Provider business mailing address

4211 WAIALAE AVE STE 208
HONOLULU HI
96816-5312
US

V. Phone/Fax

Practice location:
  • Phone: 808-888-5228
  • Fax: 808-888-7292
Mailing address:
  • Phone: 808-888-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number504
License Number StateMP
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2010-0144
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-18432
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: