Healthcare Provider Details

I. General information

NPI: 1740427343
Provider Name (Legal Business Name): JAMA JAHANYAR M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST STE 702
HONOLULU HI
96813-2496
US

IV. Provider business mailing address

550 S BERETANIA ST STE 702
HONOLULU HI
96813-2496
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-8808
  • Fax:
Mailing address:
  • Phone: 808-691-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number50929
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD-22879
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: