Provider Demographics
NPI:1285707547
Name:JAO, ROBERT VIT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VIT
Last Name:JAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ULUNIU ST STE 113
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2531
Mailing Address - Country:US
Mailing Address - Phone:808-263-4665
Mailing Address - Fax:808-263-4718
Practice Address - Street 1:407 ULUNIU ST STE 113
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2531
Practice Address - Country:US
Practice Address - Phone:808-263-4665
Practice Address - Fax:808-263-4718
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9896174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00232801Medicaid
HIG57692Medicare UPIN
HIH50484Medicare ID - Type Unspecified