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General NPI Number Information
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NPI Number | 1659454635
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Entity Type | Organization
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Legal Business Name | KEITH T MATSUMOTO MD INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 1319 PUNAHOU ST SUITE 900
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City | HONOLULU
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State | HI
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Zip | 96826-1032
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Country | US
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Telephone | 808-949-0011
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Fax | 808-943-2536
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Provider Business Mailing Address
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Address Line | 1319 PUNAHOU ST SUITE 900
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City | HONOLULU
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State | HI
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Zip | 96826-1032
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Country | US
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Telephone | 808-949-0011
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Fax | 808-943-2536
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEITH TSUGIO MATSUMOTO
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Credential | MD
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Telephone | 808-949-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4464
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License Number State | HI
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