Provider Demographics
NPI:1639341886
Name:PHYSICIAN PROVIDERS, INC.
Entity Type:Organization
Organization Name:PHYSICIAN PROVIDERS, INC.
Other - Org Name:HAWAII UENO MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RADY
Authorized Official - Last Name:MAGAURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-926-9911
Mailing Address - Street 1:1777 ALA MOANA BLVD
Mailing Address - Street 2:LOBBY LEVEL - ILIKAI HOTEL
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1603
Mailing Address - Country:US
Mailing Address - Phone:808-926-9911
Mailing Address - Fax:808-949-7771
Practice Address - Street 1:1777 ALA MOANA BLVD
Practice Address - Street 2:LOBBY LEVEL - ILIKAI HOTEL
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1603
Practice Address - Country:US
Practice Address - Phone:808-926-9911
Practice Address - Fax:808-949-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHHUMCMedicare PIN