Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | DIO-97 | HI |
NPI | 1518919620 |
---|---|
Provider Name | Mr. Doss K Tannehill |
First Address | Honolulu, HI 96816-4102 |
Second Address | Honolulu, HI 96816-4102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00614018 | ALOHACARE (01) | HI |
061401-02 | (05) | HI |
84875 | KAISER AFFILIATED CARE NU (01) | HI |