=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063183713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANN S HARADA, MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2021
-----------------------------------------------------
Last Update Date | 09/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 LUSITANA ST STE 600
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-773-8678
-----------------------------------------------------
Fax | 808-773-8679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 LUSITANA ST STE 600
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-773-8678
-----------------------------------------------------
Fax | 808-773-8679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ANN S HARADA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 775-354-3686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------