Provider Demographics
NPI:1417089103
Name:MIRZAI, TODD HM (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:HM
Last Name:MIRZAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 S BERETANIA ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1301
Mailing Address - Country:US
Mailing Address - Phone:808-952-9779
Mailing Address - Fax:808-952-9988
Practice Address - Street 1:1907 S BERETANIA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1301
Practice Address - Country:US
Practice Address - Phone:808-952-9779
Practice Address - Fax:808-952-9988
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11980208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5797799OtherUHA OAHU PIN
HIC236095OtherHMSA OAHU PIN
HID0236093OtherKAUAI HMSA PIN
HIA236099OtherMAUI HMSA PIN
HIE0236090OtherMAUI 2 HMSA PIN
HIP00019092OtherMEDICARE RAILROAD PIN
HIH78927Medicare UPIN
HI54981Medicare ID - Type UnspecifiedPROVIDER NUMBER