=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447438494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI PAIGE GOH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2008
-----------------------------------------------------
Last Update Date | 04/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 S BERETANIA ST STE 601
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-691-8877
-----------------------------------------------------
Fax | 808-691-8875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 S BERETANIA ST STE 601
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-691-8877
-----------------------------------------------------
Fax | 808-691-8875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | MD-13899
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------