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General NPI Number Information
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NPI Number | 1932304565
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Entity Type | Organization
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Legal Business Name | RICHARD A RIDAO MD LLC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 1481 S KING ST STE 343
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City | HONOLULU
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State | HI
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Zip | 96814-2602
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Country | US
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Telephone | 808-678-1900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25370
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City | HONOLULU
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State | HI
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Zip | 96825-0370
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Country | US
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Telephone | 808-536-0300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD A RIDAO
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Credential | MD
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Telephone | 808-678-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 6904
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License Number State | HI
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