Healthcare Provider Details

I. General information

NPI: 1346529450
Provider Name (Legal Business Name): MIDORI INTERNATIONAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2011
Last Update Date: 08/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6629 MAMALAHOA HWY
KEALAKEKUA HI
96750-8184
US

IV. Provider business mailing address

81-6629 MAMALAHOA HWY
KEALAKEKUA HI
96750-8184
US

V. Phone/Fax

Practice location:
  • Phone: 808-324-6888
  • Fax: 808-324-7888
Mailing address:
  • Phone: 808-324-6888
  • Fax: 808-324-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMD 7978
License Number StateHI

VIII. Authorized Official

Name: MRS. JARMILA WILLIAMS
Title or Position: CONTROLLER
Credential:
Phone: 808-324-6888