Provider Demographics
NPI:1326761867
Name:WAYNE SUGA, M.D.
Entity Type:Organization
Organization Name:WAYNE SUGA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-484-5656
Mailing Address - Street 1:98-1238 KAAHUMANU ST STE 304
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3250
Mailing Address - Country:US
Mailing Address - Phone:808-484-5656
Mailing Address - Fax:808-484-5657
Practice Address - Street 1:98-1238 KAAHUMANU ST STE 304
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3250
Practice Address - Country:US
Practice Address - Phone:808-484-5656
Practice Address - Fax:808-484-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI62972Medicaid