Provider Demographics
NPI:1245655794
Name:LUM DEZZANI, MARNI (MD)
Entity type:Individual
Prefix:DR
First Name:MARNI
Middle Name:
Last Name:LUM DEZZANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARNI
Other - Middle Name:
Other - Last Name:DEZZANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1808 KANAKANUI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3150 MONSARRAT AVE STE 200
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-4488
Practice Address - Country:US
Practice Address - Phone:808-735-5541
Practice Address - Fax:808-734-5923
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD101062080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine