MEDICARE: JOANNA AJEX PALVANNAN MD

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	2084P0800X	Psychiatry Physician	MDR-9222	HI

General Provider Information

NPI Number	:	1497449466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA AJEX PALVANNAN MD

Provider Business Mailing Address
First Line	:	1356 LUSITANA ST FL 4
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2409
Country	:	US
Telephone Number	:	808-691-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1356 LUSITANA ST FL 4
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2409
Country	:	US
Telephone Number	:	808-691-1000
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/08/2026

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