=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275828907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANICE MATSUNAGA, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2011
-----------------------------------------------------
Last Update Date | 06/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 LUSITANA STREET SUITE 507
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-532-0155
-----------------------------------------------------
Fax | 808-532-0160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 LUSITANA STREET SUITE 507
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-532-0155
-----------------------------------------------------
Fax | 808-532-0160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANICE MATSUNAGA
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 808-532-0155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 5265
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------