NPI |
1184284994 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
PARK |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider First Name |
BRYAN |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
45-090 NAMOKU ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
KANEOHE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
HI |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
967445305 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
8082476211 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
6/14/2019 |
The fax number associated with the location
address of the provider being identified. |
Last Update Date |
6/14/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
M |
The date that a record was last updated or changed. |
Healthcare Provider Taxonomy Code 1 |
225200000X |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider License Number 1 |
PTA-447 |
The first name of the authorized official. |
Provider License Number State Code 1 |
HI |
The title or position of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The 10-position telephone number of the authorized official. |
Is Sole Proprietor |
N |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |