Provider Demographics
NPI:1891119723
Name:JOSE M. MADAMBA, MD., INC.
Entity Type:Organization
Organization Name:JOSE M. MADAMBA, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1808-523-7955
Mailing Address - Street 1:1712 LILIHA STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-523-7955
Mailing Address - Fax:808-536-9498
Practice Address - Street 1:1712 LILIHA STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-523-7955
Practice Address - Fax:808-536-9498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE M. MADAMBA MD., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-2920208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000040394OtherHMSA/BCBS
HID3667301Medicaid
0000040394OtherHMSA/BCBS
HID3667301Medicaid