Provider Demographics
NPI:1437271962
Name:GORDON C. ONTAI, M.D., INC.
Entity Type:Organization
Organization Name:GORDON C. ONTAI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ONTAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-523-9300
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-523-9300
Mailing Address - Fax:808-523-8834
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-523-9300
Practice Address - Fax:808-523-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02790601Medicaid
HIH0000BDCXPMedicare PIN
HI02790601Medicaid