Provider Demographics
NPI:1386815603
Name:JON F GRAHAM MD LLC
Entity Type:Organization
Organization Name:JON F GRAHAM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-550-4939
Mailing Address - Street 1:1380 LUSITANA ST STE 502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2441
Mailing Address - Country:US
Mailing Address - Phone:808-550-4939
Mailing Address - Fax:808-550-2842
Practice Address - Street 1:1380 LUSITANA ST STE 502
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2441
Practice Address - Country:US
Practice Address - Phone:808-550-4939
Practice Address - Fax:808-550-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI024320Medicaid
HIH52774Medicare PIN
HI024320Medicaid