Healthcare Provider Details

I. General information

NPI: 1649453929
Provider Name (Legal Business Name): ALLAN NATHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 LONO AVE
KAHULUI HI
96732-1614
US

IV. Provider business mailing address

48 LONO AVE
KAHULUI HI
96732-1614
US

V. Phone/Fax

Practice location:
  • Phone: 808-871-7772
  • Fax: 808-872-4029
Mailing address:
  • Phone: 808-871-7772
  • Fax: 808-872-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD-14215
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: