Provider Demographics
NPI:1801186093
Name:JORDAN S POPPER MD INC
Entity Type:Organization
Organization Name:JORDAN S POPPER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-545-3660
Mailing Address - Street 1:PO BOX 37925
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96837-0925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98-1079 MOANALUA RD STE 410
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4715
Practice Address - Country:US
Practice Address - Phone:808-532-2277
Practice Address - Fax:808-532-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1647OtherALOHA CARE
HI02789501Medicaid
0000BBNDOOtherMEDICARE
3120-3OtherHMSA
C98894Medicare UPIN