Provider Demographics
NPI:1912073891
Name:SIRA, SANTAD - (MD)
Entity type:Individual
Prefix:DR
First Name:SANTAD
Middle Name:-
Last Name:SIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SANTAD
Other - Middle Name:-
Other - Last Name:SIRACHAINANTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0050
Mailing Address - Country:US
Mailing Address - Phone:808-322-3434
Mailing Address - Fax:808-322-4011
Practice Address - Street 1:79-7266 MAMALAHOA HWY
Practice Address - Street 2:HONALO BUSINESS CENTER#4
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7919
Practice Address - Country:US
Practice Address - Phone:808-322-3434
Practice Address - Fax:808-322-4011
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI02682207V00000X
CAA029663207V00000X
OH37681207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03541902Medicaid
HI03541901OtherKAISER
HI03541902Medicaid
HI03541901OtherKAISER