Provider Demographics
NPI:1063516227
Name:SUGAI, BRIAN T (DPM)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:SUGAI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AUPUNI ST
Mailing Address - Street 2:STE 238
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4261
Mailing Address - Country:US
Mailing Address - Phone:808-935-5597
Mailing Address - Fax:808-935-7904
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:STE 238
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4261
Practice Address - Country:US
Practice Address - Phone:808-935-5597
Practice Address - Fax:808-935-7904
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-118213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03103001Medicaid
0541010001Medicare NSC
HIH0000SCBDVMedicare PIN
040419Medicare UPIN