Provider Demographics
NPI:1326019704
Name:CHRISTENSEN, SUSAN MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MARGARET
Other - Last Name:MCVICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 PAUKIKI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 S BERETANIA ST STE 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2423
Practice Address - Country:US
Practice Address - Phone:808-691-8877
Practice Address - Fax:808-691-8875
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12360207Q00000X
HIMD-12360207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI547-408Medicaid
HI98670Medicare UPIN
HI547-408Medicaid