Provider Demographics
NPI:1255428421
Name:SUZUKI, MONA N (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:N
Last Name:SUZUKI
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 1:98-1247 KAAHUMANU ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5311
Mailing Address - Country:US
Mailing Address - Phone:808-484-2904
Mailing Address - Fax:808-484-2908
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:SUITE 217
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5311
Practice Address - Country:US
Practice Address - Phone:808-484-2904
Practice Address - Fax:808-484-2908
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD9649OtherLICENSE NO.
HI002637-01Medicaid
HI99-0331729OtherTAX ID
HIK21247-8OtherHMSA
HIMD9649OtherLICENSE NO.
HI50492Medicare ID - Type Unspecified