Provider Demographics
NPI:1669738290
Name:ENO, JONATHAN-JAMES TADAO (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN-JAMES
Middle Name:TADAO
Last Name:ENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KUMULIPO PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-3501
Mailing Address - Country:US
Mailing Address - Phone:808-280-4430
Mailing Address - Fax:
Practice Address - Street 1:85 MAUI LANI PKWY
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2416
Practice Address - Country:US
Practice Address - Phone:808-442-5700
Practice Address - Fax:877-827-2321
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126858207XX0005X
390200000X
HIMD-22036207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program