Provider Demographics
NPI:1306048400
Name:BENDTSEN, DAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:BENDTSEN
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:PO BOX 22562
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2562
Mailing Address - Country:US
Mailing Address - Phone:808-375-3249
Mailing Address - Fax:
Practice Address - Street 1:640 ULUKAHIKI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4454
Practice Address - Country:US
Practice Address - Phone:808-263-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12737207L00000X
HI13113207L00000X, 207LP2900X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ363396Medicaid
NV1306048400Medicaid
AZ363396Medicaid
NVV30408Medicare PIN