Provider Demographics
NPI:1982987921
Name:CUNANAN, JENNIFER CONCEPCION (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CONCEPCION
Last Name:CUNANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PACPACO
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 S. BERETANIA ST. #850
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-983-6206
Mailing Address - Fax:808-983-6476
Practice Address - Street 1:1401 S. BERETANIA ST. #850
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-983-6206
Practice Address - Fax:808-983-6476
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119062208000000X
AZ521922080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics