Provider Demographics
NPI:1285631952
Name:BORANIAN, DICKRAN O (MD)
Entity Type:Individual
Prefix:
First Name:DICKRAN
Middle Name:O
Last Name:BORANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 170 HUALALAI RD
Mailing Address - Street 2:SUITE C110
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1780
Mailing Address - Country:US
Mailing Address - Phone:808-329-9211
Mailing Address - Fax:808-329-0009
Practice Address - Street 1:75 170 HUALALAI RD
Practice Address - Street 2:SUITE C110
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1780
Practice Address - Country:US
Practice Address - Phone:808-329-9211
Practice Address - Fax:808-329-0009
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 6802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05965201Medicaid
HI54385Medicare ID - Type Unspecified
HI05965201Medicaid