=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558007336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANINA PAULA T SY-GO MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2022
-----------------------------------------------------
Last Update Date | 05/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 642 ULUKAHIKI ST STE 211
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-4439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-744-9429
-----------------------------------------------------
Fax | 808-772-4025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 642 ULUKAHIKI ST STE 211
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-4439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-744-9429
-----------------------------------------------------
Fax | 808-772-4025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANINA PAULA T SY-GO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-462-7662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------