Provider Demographics
NPI:1235549056
Name:HAWAII PODIATRY INC
Entity Type:Organization
Organization Name:HAWAII PODIATRY INC
Other - Org Name:HAWAII PODIATRY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-726-2161
Mailing Address - Street 1:1245 KUALA ST
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3900
Mailing Address - Country:US
Mailing Address - Phone:808-726-2161
Mailing Address - Fax:808-726-2163
Practice Address - Street 1:1245 KUALA ST
Practice Address - Street 2:SUITE 102A
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3900
Practice Address - Country:US
Practice Address - Phone:808-726-2161
Practice Address - Fax:808-726-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-196213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI7380140001OtherMEDICARE NSC