Healthcare Provider Details

I. General information

NPI: 1053483123
Provider Name (Legal Business Name): ELNA M. MASUDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

888 S KING ST STRAUB DEPARTMENT OF VASCULAR SURGERY
HONOLULU HI
96813-3097
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4000
  • Fax: 808-522-4523
Mailing address:
  • Phone: 808-522-4000
  • Fax: 808-522-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD-6210
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: