Basic Information
| Provider Information | |||||||||
| NPI: | 1659866085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MATT SLAVIN MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 848 S BERETANIA ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0853690300 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 N KUAKINI ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085362236 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | SLAVIN | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8082716617 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 52912501 | 05 | HI | MEDICAID |