Provider Demographics
NPI:1740321991
Name:WAYNE K. GOTO, MD, INC.
Entity type:Organization
Organization Name:WAYNE K. GOTO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-949-7444
Mailing Address - Street 1:1600 KAPIOLANI BLVD STE 1306
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3805
Mailing Address - Country:US
Mailing Address - Phone:808-949-7444
Mailing Address - Fax:808-949-6262
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 1306
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3805
Practice Address - Country:US
Practice Address - Phone:808-949-7444
Practice Address - Fax:808-949-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD61182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05916801Medicaid
HI05916801Medicaid