=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134540404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLYN J. MAI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2014
-----------------------------------------------------
Last Update Date | 06/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1522 MAKALOA ST SUITE 201
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-469-1997
-----------------------------------------------------
Fax | 808-941-6965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1522 MAKALOA ST. SUITE 201
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-469-1997
-----------------------------------------------------
Fax | 808-941-6965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CAROLYN J. MAI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-469-1997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | MD-7155
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------