Provider Demographics
NPI:1013164409
Name:SHOJA, PANTEA (MD)
Entity type:Individual
Prefix:
First Name:PANTEA
Middle Name:
Last Name:SHOJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 KUALA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3900
Mailing Address - Country:US
Mailing Address - Phone:808-456-2273
Mailing Address - Fax:808-456-2274
Practice Address - Street 1:1860 ALA MOANA BLVD
Practice Address - Street 2:#101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1632
Practice Address - Country:US
Practice Address - Phone:808-921-2273
Practice Address - Fax:808-921-2274
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70149207Q00000X
HI17011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR70149OtherTRAINING PERMIT
AZR70149OtherTRAINING PERMIT
HIHD238ZMedicare PIN