Provider Demographics
NPI:1972893980
Name:PATTI K M ENDO MD INC
Entity type:Organization
Organization Name:PATTI K M ENDO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ENDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-877-3635
Mailing Address - Street 1:135 S WAKEA AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1385
Mailing Address - Country:US
Mailing Address - Phone:808-877-3635
Mailing Address - Fax:808-877-4363
Practice Address - Street 1:135 S WAKEA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1385
Practice Address - Country:US
Practice Address - Phone:808-877-3635
Practice Address - Fax:808-877-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9088207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07506301Medicaid
HIG03086Medicare UPIN
HI07506301Medicaid