Provider Demographics
NPI:1972675213
Name:YORK, THEODORE G (DPM)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:G
Last Name:YORK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:#1401
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-591-2131
Mailing Address - Fax:808-593-9662
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:#1401
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-591-2131
Practice Address - Fax:808-593-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIP053213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04291001Medicaid
H0000SCBBMMedicare ID - Type Unspecified
T83241Medicare UPIN