Healthcare Provider Details

I. General information

NPI: 1013195288
Provider Name (Legal Business Name): BOYD. J. SLOMOFF M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S. KING STREET SUITE #980
HONOLULU HI
96813
US

IV. Provider business mailing address

4348 WAIALAE #565
HONOLULU HI
96816
US

V. Phone/Fax

Practice location:
  • Phone: 808-551-5168
  • Fax: 808-521-8046
Mailing address:
  • Phone: 808-738-0501
  • Fax: 808-738-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMD4063
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD#4063
License Number StateHI

VIII. Authorized Official

Name: MISS TAMERA L MEZNARICH
Title or Position: BILLER
Credential:
Phone: 808-738-0501