Provider Demographics
NPI:1104913946
Name:ANEGAWA, LINDA J S (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J S
Last Name:ANEGAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:J
Other - Last Name:SCHATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 CRANE ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4260
Mailing Address - Country:US
Mailing Address - Phone:650-498-6770
Mailing Address - Fax:
Practice Address - Street 1:1712 LILIHA ST STE 205
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3100
Practice Address - Country:US
Practice Address - Phone:808-219-0527
Practice Address - Fax:808-913-3824
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72637207R00000X
HIMD-13216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000252874OtherHMSA BILLING NUMBER
HI56870101Medicaid
HIH74081Medicare UPIN
HI100516Medicare PIN