Provider Demographics
NPI:1245343565
Name:SUGA, WAYNE M (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:M
Last Name:SUGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST.
Mailing Address - Street 2:SUITE 325
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-484-5656
Mailing Address - Fax:808-484-5657
Practice Address - Street 1:98-211 PALI MOMI ST.
Practice Address - Street 2:SUITE 325
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-484-5656
Practice Address - Fax:808-484-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI5935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
54974Medicare ID - Type Unspecified
HIH54974Medicare PIN
D43505Medicare UPIN