Provider Demographics
NPI:1710046891
Name:STEPHEN H TENBY MD LTD
Entity Type:Organization
Organization Name:STEPHEN H TENBY MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:TENBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-732-2848
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5312
Mailing Address - Country:US
Mailing Address - Phone:808-732-2848
Mailing Address - Fax:808-732-2840
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5312
Practice Address - Country:US
Practice Address - Phone:808-732-2848
Practice Address - Fax:808-732-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02839001Medicaid
0000031682OtherHMSA
C98955Medicare UPIN
HI02839001Medicaid