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General NPI Number Information
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NPI Number | 1891119723
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Entity Type | Organization
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Legal Business Name | JOSE M. MADAMBA, MD., INC.
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1712 LILIHA STREET SUITE 203
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-523-7955
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Fax | 808-536-9498
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Provider Business Mailing Address
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Address Line | 1712 LILIHA STREET SUITE 203
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-523-7955
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Fax | 808-536-9498
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSE M. MADAMBA
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Credential | MD
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Telephone | 18085237955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD-2920
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License Number State | HI
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