Wahiawa Family Practice Clinic Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

MD11212 Issued in HI

Legal business name

WAHIAWA FAMILY PRACTICE CLINIC INC

Practice address

302 California Ave
Suite 103
Wahiawa, HI 96786-1841

Phone

(808) 621-7733

Fax

(808) 621-7799

NPI assigned

Aug 29, 2006

Last updated

Aug 22, 2020By 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

Dr. Jason Tai Pang Lam, MDNPI 1114033040

Title

President

Phone

(808) 621-7733

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 5

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.

• Jason Tai Pang Lam, MD

  • Adult Medicine Physician
  • Wahiawa, HI
  • NPI 1114033040
  Medicare reassignment NPD Authorized official
• George J Chu, MD

  • Allergy & Immunology Physician
  • Honolulu, HI
  • NPI 1316044969
  NPD (past)
• Szeming Suen, MD

  • Surgery Physician
  • Wahiawa, HI
  • NPI 1699976449
  NPD (past)
• Macrina U Vicerra-Jaena, APRN

  • Family Nurse Practitioner
  • Ewa Beach, HI
  • NPI 1992758015
  NPD (past)
• Baron CKW Wong, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Waipahu, HI
  • NPI 1093745523
  NPD (past)

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386753903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 CALIFORNIA AVE",
            "address_2": "SUITE 103",
            "city": "WAHIAWA",
            "state": "HI",
            "postal_code": "967861841",
            "telephone_number": "808-621-7733",
            "fax_number": "808-621-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 CALIFORNIA AVE",
            "address_2": "SUITE 103",
            "city": "WAHIAWA",
            "state": "HI",
            "postal_code": "967861841",
            "telephone_number": "808-621-7733",
            "fax_number": "808-621-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHIAWA FAMILY PRACTICE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "TAI PANG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-621-7733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "HI",
            "license": "MD11212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sadie Verdadero
• Leona Vik
• Mark Thomas Villanueva
• Brian Vongchanphen, DDS
• Wahiawa Family Dental Care, LLP
• Wahiawa General Hospital
• Wahiawa General Hospital
• Wahiawa General Hospital
• Wahiawa General Hospital
• Wahiawa General Hospital

• Clinic/Center in Wahiawa, HI
• Providers in Wahiawa, HI by specialty
• Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.