Healthcare Provider Details

I. General information

NPI: 1841563533
Provider Name (Legal Business Name): BLUDOC PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 02/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-993 UKUWAI ST #2602
MILILANI HI
96789-6948
US

IV. Provider business mailing address

95-993 UKUWAI ST #2602
MILILANI HI
96789-6948
US

V. Phone/Fax

Practice location:
  • Phone: 808-722-8792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberMD 14643
License Number StateHI

VIII. Authorized Official

Name: DR. TOYIN AJOSE
Title or Position: PRESIDENT
Credential: MD
Phone: 808-722-8792