Provider Demographics
NPI:1679005235
Name:HAZAMA, DEVIN I I (DO)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:I
Last Name:HAZAMA
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89-102 FARRINGTON HWY UNIT 3000
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-4160
Mailing Address - Country:US
Mailing Address - Phone:808-697-3900
Mailing Address - Fax:
Practice Address - Street 1:89-102 FARRINGTON HWY UNIT 3000
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-4160
Practice Address - Country:US
Practice Address - Phone:808-697-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIDOS-2062207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program