Provider Demographics
NPI:1407815285
Name:GLEN H SUGIYAMA
Entity Type:Organization
Organization Name:GLEN H SUGIYAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUGIYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-538-3021
Mailing Address - Street 1:820 MILILANI ST
Mailing Address - Street 2:SUITE 702A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-523-9363
Mailing Address - Fax:808-523-9418
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-538-3021
Practice Address - Fax:808-553-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53209Medicare ID - Type UnspecifiedGROUP