Provider Demographics
NPI:1538330147
Name:DAVID JOHN MD INC
Entity Type:Organization
Organization Name:DAVID JOHN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECISLIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:808-531-7111
Mailing Address - Street 1:1329 LUSITANA ST STE 804
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2434
Mailing Address - Country:US
Mailing Address - Phone:808-531-7111
Mailing Address - Fax:
Practice Address - Street 1:1329 LUSITANA ST STE 804
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2434
Practice Address - Country:US
Practice Address - Phone:808-531-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC17172OtherHMSA
HI52447201Medicaid
HI01601501Medicaid
HI01601501Medicaid
HIC17172OtherHMSA