=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063965465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAITO PEDIATRICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2016
-----------------------------------------------------
Last Update Date | 08/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4211 WAIALAE AVE STE 205
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-754-2950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4211 WAIALAE AVE STE 205
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-754-2950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERISE SAITO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-754-2950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 16839
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------