Provider Demographics
NPI:1255482238
Name:MIN, RICHARD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:MIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST.
Mailing Address - Street 2:SUITE 515
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2441
Mailing Address - Country:US
Mailing Address - Phone:808-523-3859
Mailing Address - Fax:808-521-4285
Practice Address - Street 1:1380 LUSITANA ST.
Practice Address - Street 2:SUITE 515
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2441
Practice Address - Country:US
Practice Address - Phone:808-523-3859
Practice Address - Fax:808-521-4285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI3993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00X0052774Medicaid
HID36200Medicare UPIN
HI51479Medicare ID - Type Unspecified