Provider Demographics
NPI:1104007491
Name:SHIGEKO LAU, M.D., LLC
Entity Type:Organization
Organization Name:SHIGEKO LAU, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIGEKO
Authorized Official - Middle Name:OKAMOTO
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-599-4004
Mailing Address - Street 1:1100 WARD AVE.
Mailing Address - Street 2:SUITE 1065
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1617
Mailing Address - Country:US
Mailing Address - Phone:808-599-4004
Mailing Address - Fax:808-599-4007
Practice Address - Street 1:1100 WARD AVE.
Practice Address - Street 2:SUITE 1065
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1617
Practice Address - Country:US
Practice Address - Phone:808-599-4004
Practice Address - Fax:808-599-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4093208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04786003Medicaid
HI04786003Medicaid