Provider Demographics
NPI:1790840718
Name:DONNA JEAN MAH MD INC
Entity Type:Organization
Organization Name:DONNA JEAN MAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-593-8686
Mailing Address - Street 1:1314 S KING ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-593-8686
Mailing Address - Fax:808-597-1288
Practice Address - Street 1:1314 S KING ST
Practice Address - Street 2:SUITE 414
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-593-8686
Practice Address - Fax:808-597-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 1003208000000X
HIMD 7068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00694001Medicaid
HI05968501Medicaid
D36293Medicare UPIN