Provider Demographics
NPI:1275828907
Name:JANICE MATSUNAGA, M.D., INC.
Entity Type:Organization
Organization Name:JANICE MATSUNAGA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:808-532-0155
Mailing Address - Street 1:1329 LUSITANA STREET
Mailing Address - Street 2:SUITE 507
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2412
Mailing Address - Country:US
Mailing Address - Phone:808-532-0155
Mailing Address - Fax:808-532-0160
Practice Address - Street 1:1329 LUSITANA STREET
Practice Address - Street 2:SUITE 507
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2412
Practice Address - Country:US
Practice Address - Phone:808-532-0155
Practice Address - Fax:808-532-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5265207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01882001Medicaid
HI01882001Medicaid
D36192Medicare UPIN