Healthcare Provider Details

I. General information

NPI: 1457548596
Provider Name (Legal Business Name): DAVID G SERIGUCHI, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 08/14/2008
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: 808-242-0068
Mailing address:
  • Phone: 808-242-5544
  • Fax: 808-242-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number5286
License Number StateHI

VIII. Authorized Official

Name: DR. DAVID G SERIGUCHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-242-5544