Provider Demographics
NPI:1225135908
Name:MADANAY, LYNN DEREK
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:DEREK
Last Name:MADANAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 N KUAKINI ST
Mailing Address - Street 2:KUAKINI MEDICAL CENTER DEPARTMENT OF NUCLEAR MEDICINE
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2336
Mailing Address - Country:US
Mailing Address - Phone:808-547-9549
Mailing Address - Fax:808-547-9554
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:KUAKINI MEDICAL CENTER DEPARTMENT OF NUCLEAR MEDICINE
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2336
Practice Address - Country:US
Practice Address - Phone:808-547-9549
Practice Address - Fax:808-547-9554
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4768207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01326502Medicaid
E57476Medicare UPIN
HI01326502Medicaid