Basic Information
| Provider Information | |||||||||
| NPI: | 1972691509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADA | ||||||||
| FirstName: | RANDAL | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 677 ALA MOANA BLVD | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089569829 | ||||||||
| FaxNumber: | 8085379294 | ||||||||
| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST | ||||||||
| Address2: | PEDIATRIC AMBULATORY UNIT | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089838551 | ||||||||
| FaxNumber: | 8089838005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 01/20/2014 | ||||||||
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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 | 2080P0207X | MD-9666 | HI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.