Provider Demographics
NPI:1124249230
Name:URGENT CARE MAUI INC.
Entity type:Organization
Organization Name:URGENT CARE MAUI INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYON
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAVAKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-879-7781
Mailing Address - Street 1:1325 S. KIHEI RD.
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-879-7781
Mailing Address - Fax:808-879-0594
Practice Address - Street 1:1325 S. KIHEI RD.
Practice Address - Street 2:SUITE # 103
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753
Practice Address - Country:US
Practice Address - Phone:808-879-7781
Practice Address - Fax:808-879-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51100Medicare ID - Type Unspecified