Outreach Medical Group Downtown LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

OUTREACH MEDICAL GROUP DOWNTOWN LLC

Practice address

928 Nuuanu Ave # 1-C
Honolulu, HI 96817-5190

Phone

(808) 845-5550

Fax

(808) 845-5557

NPI assigned

Nov 15, 2022

Last updated

Aug 2, 2023By 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

Mr. Derek M Tengan, PHARM.D.

Title

Member

Phone

(808) 845-5550

Specialties & licenses 1

Addresses

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

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690934400000",
    "number": "1659080901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94-449 AKOKI ST STE 104",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967972732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 NUUANU AVE # 1-C",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968175190",
            "telephone_number": "808-845-5550",
            "fax_number": "808-845-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH MEDICAL GROUP DOWNTOWN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A",
        "authorized_official_last_name": "TENGAN",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "808-845-5550",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Honolulu, HI
• Providers in Honolulu, HI by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.