Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | D10653 | OR |
N | 213EG0000X | General Practice | D10653 | OR |
Y | 1223G0001X | General Practice | DT2716 | HI |
Y | 213EG0000X | General Practice | DT2716 | HI |
NPI | 1003277922 |
---|---|
Provider Name | Dr. Alex Matsumoto |
First Address | Honolulu, HI 96817-1413 |
Second Address | Honolulu, HI 96817-4544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2016 |
Last Update Date | 28/03/2021 |