NPIMap

Individual provider Active NPI

Malissa Hyun Kyung Iida-Takashima, MD

  • Internal Medicine Physician
  • Aiea, HI
National Provider Identifier
1083810642
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MDR5282 Issued in HI
Practice address
98-1079 Moanalua Rd
Ste 500
Aiea, HI 96701-4713
Phone
(808) 488-0990
NPI assigned
Jun 21, 2007
Last updated
Sep 19, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MDR5282 HI Primary

Addresses

Primary practice location

98-1079 Moanalua Rd
Ste 500
Aiea, HI 96701-4713

Mailing address

98-1079 Moanalua Rd
Ste 500
Aiea, HI 96701-4713
Phone (808) 488-0990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000441 HI Practitioner - Internal Medicine 1052436797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Hawaii John a. Burns School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pearl City Medical Associates IncGroup PAC ID 1456332238, 8 clinicians

Practice addresses (Care Compare)

98 -1079 Moanalua Rd
Suite 500
Aiea, HI 96701-4794
Phone (808) 488-0990

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MDR5282HIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pearl City Medical Associates, Inc. Internal Medicine CurrentSince Sep 1, 2010 Accepting new patients
Inteleretina Professional Group LLC Past Accepting new patients

Locations

98-1079 Moanalua Rd
Ste 500
Aiea, HI 96701
Phone (808) 488-0990

Networks

  • HI PPO
  • devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1083810642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98-1079 MOANALUA RD",
            "address_2": "STE 500",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014713",
            "telephone_number": "808-488-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-1079 MOANALUA RD",
            "address_2": "STE 500",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014713",
            "telephone_number": "808-488-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IIDA-TAKASHIMA",
        "first_name": "MALISSA",
        "middle_name": "HYUN KYUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MDR5282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

Verify at the official NPI Registry.