Provider Demographics
NPI:1477639052
Name:SERIGUCHI, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:SERIGUCHI
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 1:1931 E VINEYARD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1700
Mailing Address - Country:US
Mailing Address - Phone:808-242-5544
Mailing Address - Fax:808-242-0098
Practice Address - Street 1:1931 E VINEYARD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1700
Practice Address - Country:US
Practice Address - Phone:808-242-5544
Practice Address - Fax:808-242-0098
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01941401Medicaid
H0000BDZGNMedicare ID - Type Unspecified
HI01941401Medicaid