Healthcare Provider Details

I. General information

NPI: 1407893241
Provider Name (Legal Business Name): WESLEY J. SUGAI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-990 HALEKII ST SUITE 150
KEALAKEKUA HI
96750-8155
US

IV. Provider business mailing address

81-990 HALEKII ST SUITE 150
KEALAKEKUA HI
96750-8155
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-7719
  • Fax: 808-329-7518
Mailing address:
  • Phone: 808-329-7719
  • Fax: 808-329-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-5336
License Number StateHI

VIII. Authorized Official

Name: MRS. PATRICIA SUGAI
Title or Position: CORPORATE SECRETARY/ACCOUNTANT
Credential:
Phone: 808-329-7719