Basic Information
| Provider Information | |||||||||
| NPI: | 1831126556 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ODA | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 KAPIOLANI BLVD | ||||||||
| Address2: | #705 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085978791 | ||||||||
| FaxNumber: | 8085978781 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
| Address2: | EMERGENCY DEPT. QUEEN'S MEDICAL CENTER | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085978791 | ||||||||
| FaxNumber: | 8085978781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 06/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD6151 | HI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02968801 | 05 | HI | MEDICAID |