Provider Demographics
NPI:1952571416
Name:TIMOTHY HAGINO, M.D. LLC
Entity Type:Organization
Organization Name:TIMOTHY HAGINO, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HIROSHI
Authorized Official - Last Name:HAGINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-486-4144
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3916
Mailing Address - Country:US
Mailing Address - Phone:808-486-4144
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 110
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3916
Practice Address - Country:US
Practice Address - Phone:808-486-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6994207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty