Provider Demographics
NPI:1346803731
Name:AZUMA, LAUREN (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:AZUMA
Suffix:
Gender:F
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 3001
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96802-3001
Mailing Address - Country:US
Mailing Address - Phone:808-452-0288
Mailing Address - Fax:808-490-0836
Practice Address - Street 1:2361 AHAIKI ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1109
Practice Address - Country:US
Practice Address - Phone:808-452-0288
Practice Address - Fax:808-490-0836
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA179775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program