Basic Information
| Provider Information | |||||||||
| NPI: | 1013164409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOJA | ||||||||
| FirstName: | PANTEA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 KUALA ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967823900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084562273 | ||||||||
| FaxNumber: | 8084562274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 ALA MOANA BLVD | ||||||||
| Address2: | #101 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968151632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089212273 | ||||||||
| FaxNumber: | 8089212274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R70149 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 17011 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | R70149 | 01 | AZ | TRAINING PERMIT | OTHER |