Provider Demographics
NPI:1457548596
Name:DAVID G SERIGUCHI, MD INC
Entity type:Organization
Organization Name:DAVID G SERIGUCHI, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SERIGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-242-5544
Mailing Address - Street 1:1931 E VINEYARD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1700
Mailing Address - Country:US
Mailing Address - Phone:808-242-5544
Mailing Address - Fax:808-242-0068
Practice Address - Street 1:1931 E VINEYARD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1700
Practice Address - Country:US
Practice Address - Phone:808-242-5544
Practice Address - Fax:808-242-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5286261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01941401Medicaid
HI01941401Medicaid
HIHDGSMedicare PIN