Provider Demographics
NPI:1225586233
Name:JORGE C SAMANIEGO JR MD LLC
Entity type:Organization
Organization Name:JORGE C SAMANIEGO JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:808-537-1217
Mailing Address - Street 1:1177 QUEEN ST
Mailing Address - Street 2:APT. # 2306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4138
Mailing Address - Country:US
Mailing Address - Phone:808-537-1217
Mailing Address - Fax:808-597-1597
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2499
Practice Address - Country:US
Practice Address - Phone:808-691-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9469208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty