Healthcare Provider Details

I. General information

NPI: 1174884829
Provider Name (Legal Business Name): TRAVIS WATAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date: 06/10/2018
Reactivation Date: 06/20/2018

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-7657
  • Fax:
Mailing address:
  • Phone: 808-691-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number18279
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: