Provider Demographics
NPI:1407089808
Name:AIEA PEDIATRICS, LLC
Entity Type:Organization
Organization Name:AIEA PEDIATRICS, LLC
Other - Org Name:BRENT K. TAMAMOTO, M.D., LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:KOICHI
Authorized Official - Last Name:TAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-754-4212
Mailing Address - Street 1:99-080 KAUHALE ST
Mailing Address - Street 2:SUITE C-22
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4116
Mailing Address - Country:US
Mailing Address - Phone:808-487-1600
Mailing Address - Fax:808-487-1601
Practice Address - Street 1:99-080 KAUHALE ST
Practice Address - Street 2:SUITE C-22
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4116
Practice Address - Country:US
Practice Address - Phone:808-487-1600
Practice Address - Fax:808-487-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD14517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty