Provider Demographics
NPI:1154471126
Name:CHARLIE Y SONIDO MD LLC
Entity Type:Organization
Organization Name:CHARLIE Y SONIDO MD LLC
Other - Org Name:PRIMARY CARE CLINIC OF HAWAII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-690-3830
Mailing Address - Street 1:94-837 WAIPAHU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3320
Mailing Address - Country:US
Mailing Address - Phone:808-671-3911
Mailing Address - Fax:808-677-2720
Practice Address - Street 1:94-837 WAIPAHU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-671-3911
Practice Address - Fax:808-677-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4737207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID36091Medicare UPIN
HIC98676Medicare UPIN
HIC98629Medicare UPIN