Healthcare Provider Details

I. General information

NPI: 1477639052
Provider Name (Legal Business Name): DAVID G SERIGUCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 E VINEYARD ST SUITE 102
WAILUKU HI
96793-1700
US

IV. Provider business mailing address

1931 E VINEYARD ST SUITE 102
WAILUKU HI
96793-1700
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-5544
  • Fax: 808-242-0098
Mailing address:
  • Phone: 808-242-5544
  • Fax: 808-242-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5286
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: