Provider Demographics
NPI:1689441362
Name:IAN S EBESUGAWA MD
Entity Type:Organization
Organization Name:IAN S EBESUGAWA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBESUGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-969-2055
Mailing Address - Street 1:75 PUUHONU PL STE 202
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 PUUHONU PL STE 202
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2000
Practice Address - Country:US
Practice Address - Phone:808-969-2055
Practice Address - Fax:808-969-7146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology