Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD-13512 | HI |
NPI | 1316042583 |
---|---|
Provider Name | Dr. Sidney M. Johnson |
First Address | Honolulu, HI 96826-2150 |
Second Address | Honolulu, HI 96826-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000254714 | HMSA (01) | HI |
3819137 | UHA (01) | HI |
57121701 | (05) | HI |
I42266 | (02) | HI |