=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033524004
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAMED AHMADINIA M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2014
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5095 NAPILIHAU ST
-----------------------------------------------------
City | LAHAINA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96761-8800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-242-6464
-----------------------------------------------------
Fax | 808-984-7446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2180 MAIN ST
-----------------------------------------------------
City | WAILUKU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96793-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-932-3186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MDR6671
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD-24650
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------