=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235674060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORI MURAYAMA-SUNG, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2017
-----------------------------------------------------
Last Update Date | 01/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1520 LILIHA ST STE 402
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-3562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-600-4245
-----------------------------------------------------
Fax | 808-744-2640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2756 PALI HWY APT K
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-1497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-222-9575
-----------------------------------------------------
Fax | 808-744-2640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LORI SHIZUKO MURAYAMA-SUNG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-222-9575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD 15219
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------