Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD-7153 | HI |
NPI | 1003037052 |
---|---|
Provider Name | Dr. Homayon M. Tavakoli |
First Address | Kihei, HI 96753 |
Second Address | Kihei, HI 96753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E76785 | (02) |