Provider Demographics
NPI:1841957040
Name:BIUKOTO, PENI MOI (MBBS)
Entity type:Individual
Prefix:DR
First Name:PENI
Middle Name:MOI
Last Name:BIUKOTO
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3313
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-3313
Mailing Address - Country:US
Mailing Address - Phone:684-252-2022
Mailing Address - Fax:
Practice Address - Street 1:PROCUREMENT ROAD
Practice Address - Street 2:TAFUNA
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-3965
Practice Address - Country:US
Practice Address - Phone:684-699-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS3037C2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine