Provider Demographics
NPI:1790744571
Name:SUE, JEFFREY Y (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:Y
Last Name:SUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 S KING ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2601
Mailing Address - Country:US
Mailing Address - Phone:808-949-0091
Mailing Address - Fax:
Practice Address - Street 1:1481 S KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2601
Practice Address - Country:US
Practice Address - Phone:808-949-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD59572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB004OtherTRICARE
HIMD5957-01OtherQHC
HI00B0029120OtherHMSA
HI02609101Medicaid
HIA47953Medicare UPIN
HI0000BDWJDMedicare ID - Type Unspecified