Provider Demographics
NPI:1942450135
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
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?:Yes
Parent Organization LBN:NICANOR F, JOAQUIN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03624401HMedicaid
HIC98473HIMedicare UPIN