Healthcare Provider Details

I. General information

NPI: 1376817239
Provider Name (Legal Business Name): MATTHEW S. ADANIYA MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST SUITE 704
HONOLULU HI
96817-6300
US

IV. Provider business mailing address

405 N KUAKINI ST SUITE 704
HONOLULU HI
96817-6300
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-1608
  • Fax:
Mailing address:
  • Phone: 808-523-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD4956
License Number StateHI

VIII. Authorized Official

Name: DR. MATTHEW S. ADANIYA
Title or Position: PRESIDENT
Credential: MD
Phone: 808-523-1608