Provider Demographics
NPI:1952463184
Name:FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:YASUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-622-4191
Mailing Address - Street 1:34 MAKANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1914
Mailing Address - Country:US
Mailing Address - Phone:808-622-4191
Mailing Address - Fax:808-621-5742
Practice Address - Street 1:34 MAKANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1914
Practice Address - Country:US
Practice Address - Phone:808-622-4191
Practice Address - Fax:808-621-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5443207Q00000X
HI2694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50385601Medicaid
HI0-020113-7OtherHMSA
HI50385601Medicaid