=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740321991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAYNE K. GOTO, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 KAPIOLANI BLVD STE 1306
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-949-7444
-----------------------------------------------------
Fax | 808-949-6262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 KAPIOLANI BLVD STE 1306
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-949-7444
-----------------------------------------------------
Fax | 808-949-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WAYNE KAY GOTO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-949-7444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD6118
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------