Island Urology Oahu LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD-14871 Issued in HI

Legal business name

ISLAND UROLOGY OAHU LLC

Practice address

1329 Lusitana St Ste 602
Honolulu, HI 96813-2431

Phone

(808) 522-5055

Fax

(808) 524-6306

NPI assigned

Oct 2, 2012

Last updated

Oct 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sergei Tikhonenkov, M.D.NPI 1104973908

Title

Owner

Phone

(808) 522-5055

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sergei Tikhonenkov, MD

  • Urology Physician
  • Honolulu, HI
  • NPI 1104973908
  Medicare reassignment NPD Authorized official
• Randall Charles Blake, M.D.

  • Urology Physician
  • Honolulu, HI
  • NPI 1447226055
  Medicare reassignment NPD

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1235481185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 LUSITANA ST STE 602",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132431",
            "telephone_number": "808-522-5055",
            "fax_number": "808-524-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 LUSITANA ST STE 602",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132431",
            "telephone_number": "808-522-5055",
            "fax_number": "808-524-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND UROLOGY OAHU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "TIKHONENKOV",
        "authorized_official_first_name": "SERGEI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-522-5055",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "HI",
            "license": "MD-14871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island Spine and Health LLC
• Island Surgical Specialists, LLC (Michael Krishna Rao, M.D.)
• Island Urgent Care LLC
• Island Urgent Care Waikiki LLC
• Island Urology Honolulu LLC
• Island Wellness & Health Inc
• Island Wellness Center, Inc.
• Islandmed Clinic, LLC
• Islands Emergency Medical Service Hawaii, LLC
• Islands Healthcare Consultants

• Urology Physician in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Urology Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.