Healthcare Provider Details

I. General information

NPI: 1306866207
Provider Name (Legal Business Name): ANKUR JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 LILIHA ST STE 405
HONOLULU HI
96817-1605
US

IV. Provider business mailing address

2226 LILIHA ST STE 405
HONOLULU HI
96817-1605
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-1708
  • Fax:
Mailing address:
  • Phone: 808-533-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA85135
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA85135
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD17092
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: