Provider Demographics
NPI:1639502651
Name:PETER A. IN, M.D., INC.
Entity Type:Organization
Organization Name:PETER A. IN, M.D., INC.
Other - Org Name:WAIMEA COMMUNITY COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:IN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-885-7444
Mailing Address - Street 1:65-1206 MAMALAHOA HWY., STE 3-108
Mailing Address - Street 2:WAIMEA OFFICE CENTER
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-885-7444
Mailing Address - Fax:808-885-0716
Practice Address - Street 1:65-1206 MAMALAHOA HWY., STE 3-108
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7302
Practice Address - Country:US
Practice Address - Phone:808-885-7444
Practice Address - Fax:808-885-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2319103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty