Provider Demographics
NPI:1942229489
Name:SUGIHARA, JARED GENJI (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:GENJI
Last Name:SUGIHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 LILIHA ST STE 306
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1605
Mailing Address - Country:US
Mailing Address - Phone:808-531-5711
Mailing Address - Fax:808-531-5733
Practice Address - Street 1:2226 LILIHA ST STE 306
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1605
Practice Address - Country:US
Practice Address - Phone:808-531-5711
Practice Address - Fax:808-531-5733
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1750207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI034187-01Medicaid
HI1750OtherSTATE LICENSE NUMBER
HI034187-01Medicaid
HID36240Medicare UPIN