Provider Demographics
NPI:1508127838
Name:GANESH, DEVIN SELVA (MD)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:SELVA
Last Name:GANESH
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 1:30 AULIKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2750
Mailing Address - Country:US
Mailing Address - Phone:808-261-4658
Mailing Address - Fax:
Practice Address - Street 1:30 AULIKE ST STE 201
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2750
Practice Address - Country:US
Practice Address - Phone:808-261-4658
Practice Address - Fax:808-263-2036
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-20476207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8966666OtherMEDICARE PIN
WA1508127838Medicaid