Provider Demographics
NPI:1528088416
Name:CANBY-HAGINO, EDITH (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:
Last Name:CANBY-HAGINO
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 1:888 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3097
Mailing Address - Country:US
Mailing Address - Phone:808-522-4301
Mailing Address - Fax:808-522-4302
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3097
Practice Address - Country:US
Practice Address - Phone:808-522-4301
Practice Address - Fax:808-522-4302
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9031208800000X
CAGFE84137208800000X
HI17832208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C1544Medicare ID - Type Unspecified
I14569Medicare UPIN