Healthcare Provider Details

I. General information

NPI: 1255432167
Provider Name (Legal Business Name): JOHN M. SANDOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 3089 AVE. D MARINE CORPS BASE HAWAII
KANEOHE HI
96863
US

IV. Provider business mailing address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-257-3365
  • Fax: 808-257-5653
Mailing address:
  • Phone: 808-257-3365
  • Fax: 808-257-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-9892
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD-9892
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: