MEDICARE: DICKRAN O. BORANIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD 6802	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285631952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DICKRAN O. BORANIAN M.D.

Provider Business Mailing Address
First Line	:	75 170 HUALALAI RD
Second Line	:	SUITE C110
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-1780
Country	:	US
Telephone Number	:	808-329-9211
Fax Number	:	808-329-0009

Provider Business Practice Location Address
First Line	:	75 170 HUALALAI RD
Second Line	:	SUITE C110
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-1780
Country	:	US
Telephone Number	:	808-329-9211
Fax Number	:	808-329-0009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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