Healthcare Provider Details

I. General information

NPI: 1588073142
Provider Name (Legal Business Name): TAMARA KHATIB MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S BERETANIA ST STE 408
HONOLULU HI
96813-2551
US

IV. Provider business mailing address

848 S BERETANIA ST STE 408
HONOLULU HI
96813-2551
US

V. Phone/Fax

Practice location:
  • Phone: 808-679-1459
  • Fax:
Mailing address:
  • Phone: 808-679-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD17479
License Number StateHI

VIII. Authorized Official

Name: TAMARA KHATIB
Title or Position: PRESIDENT
Credential: MD
Phone: 808-679-1459