Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 1655 | HI |
Y | 213EG0000X | General Practice | 1655 | HI |
N | 1223G0001X | General Practice | 36813 | CA |
N | 213EG0000X | General Practice | 36813 | CA |
NPI | 1003822321 |
---|---|
Provider Name | Dr. Lance Diamond Ogata |
First Address | Kahului, HI 96732-2315 |
Second Address | Kahului, HI 96732-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |