Provider Demographics
NPI:1114797842
Name:HAWAII PREMIER DERMATOLOGY INC
Entity Type:Organization
Organization Name:HAWAII PREMIER DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAGAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSAEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-515-3531
Mailing Address - Street 1:590 FARRINGTON HWY # 524-529
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:808-515-3531
Mailing Address - Fax:
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 508
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3804
Practice Address - Country:US
Practice Address - Phone:808-515-3531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty