Provider Demographics
NPI:1790033454
Name:HAWAII GASTROENTEROLOGY SPECIALIST
Entity Type:Organization
Organization Name:HAWAII GASTROENTEROLOGY SPECIALIST
Other - Org Name:GI CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSIF
Authorized Official - Middle Name:I
Authorized Official - Last Name:A RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:808-486-0449
Mailing Address - Street 1:98-211 PALI MOMI ST STE 312
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4306
Mailing Address - Country:US
Mailing Address - Phone:808-486-0449
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 312
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4306
Practice Address - Country:US
Practice Address - Phone:808-486-0449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty