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General NPI Number Information
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NPI Number | 1851509202
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Entity Type | Organization
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Legal Business Name | TODD H.M. MIRZAI,M.D.,LLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 1907 S BERETANIA ST SUITE 120
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City | HONOLULU
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State | HI
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Zip | 96826-1301
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Country | US
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Telephone | 808-952-9779
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Fax | 808-952-9988
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Provider Business Mailing Address
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Address Line | 1939 E VINEYARD ST
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City | WAILUKU
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State | HI
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Zip | 96793-1714
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Country | US
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Telephone | 808-249-8509
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Fax | 808-242-9166
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Authorized Official
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Title or Position | OWNER
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Name | TODD H.M. MIRZAI
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Credential | M.D.
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Telephone | 808-952-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD11980
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License Number State | HI
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