Provider Demographics
NPI:1619373198
Name:TAI, LYNN S (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:S
Last Name:TAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 KAPIOLANI BLVD STE 1500
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4526
Mailing Address - Country:US
Mailing Address - Phone:808-531-6886
Mailing Address - Fax:808-523-5115
Practice Address - Street 1:1585 KAPIOLANI BLVD STE 1500
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4526
Practice Address - Country:US
Practice Address - Phone:085-318-6886
Practice Address - Fax:808-523-5115
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52262363A00000X
HIAMD-995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant