Provider Demographics
NPI:1851509202
Name:TODD H.M. MIRZAI,M.D.,LLC
Entity Type:Organization
Organization Name:TODD H.M. MIRZAI,M.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:HM
Authorized Official - Last Name:MIRZAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-952-9779
Mailing Address - Street 1:1939 E VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1714
Mailing Address - Country:US
Mailing Address - Phone:808-249-8509
Mailing Address - Fax:808-242-9166
Practice Address - Street 1:1907 S BERETANIA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1301
Practice Address - Country:US
Practice Address - Phone:808-952-9779
Practice Address - Fax:808-952-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11980208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID0236093OtherKAUAI HMSA PIN
HIP00019092OtherMEDICARE RAILROAD PIN
HIE0236090OtherMAUI 2 HMSA PIN
HIA236099OtherMAUI HMSA PIN
HI5797799OtherUHA PIN
HIC236095OtherHMSA OAHU PIN
HI=========OtherHMAA PIN
HIP00019092OtherMEDICARE RAILROAD PIN
HIC236095OtherHMSA OAHU PIN