NPIMap

Organization Active NPI

Pacific Training Program

  • Pediatrics Physician
  • Aiea, HI
National Provider Identifier
1407963606
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD-11341 Issued in HI
Legal business name
PACIFIC TRAINING PROGRAM
Practice address
99-128 Aiea Heights Dr
Suite 108
Aiea, HI 96701-3925
Phone
(808) 488-6846
NPI assigned
Aug 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dana Ichinotsubo
Title
Board Member
Phone
(808) 488-6846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X MD-11341 HI Primary

Addresses

Primary practice location

99-128 Aiea Heights Dr
Suite 108
Aiea, HI 96701-3925

Mailing address

99-128 Aiea Heights Dr
Suite 108
Aiea, HI 96701-3925
Phone (808) 488-6846

Other identifiers 1

IdentifierTypeStateIssuer
51484202MedicaidHI

National Provider Directory

National Provider Directory

Locations

99-128 Aiea Heights Dr
Ste 104
Aiea, HI 96701
Phone (808) 440-1141

91-2135 Fort Weaver Rd
Ste 180
Ewa Beach, HI 96706
Phone (808) 675-0400

91-775 Papipi Rd
Ewa Beach, HI 96706
Phone (808) 689-8191

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407963606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99-128 AIEA HEIGHTS DR",
            "address_2": "SUITE 108",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967013925",
            "telephone_number": "808-488-6846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99-128 AIEA HEIGHTS DR",
            "address_2": "SUITE 108",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967013925",
            "telephone_number": "808-488-6846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC TRAINING PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ICHINOTSUBO",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "808-488-6846"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "HI",
            "license": "MD-11341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51484202",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiea, HI

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.