Provider Demographics
NPI:1871866939
Name:NICANOR F JOAQUIN MD INC
Entity Type:Organization
Organization Name:NICANOR F JOAQUIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICANOR
Authorized Official - Middle Name:FLORENDO
Authorized Official - Last Name:JOAQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-841-4195
Mailing Address - Street 1:1807 N KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3447
Mailing Address - Country:US
Mailing Address - Phone:808-841-4195
Mailing Address - Fax:808-841-0627
Practice Address - Street 1:1807 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3447
Practice Address - Country:US
Practice Address - Phone:808-841-4195
Practice Address - Fax:808-841-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2755261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI036244-01Medicaid
HIC98473Medicare UPIN