Individual provider Active NPI

Jonathan H. Shun, MD

  • Internal Medicine Physician
  • Waipahu, HI
National Provider Identifier
1891873675
Registry record updated Aug 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD15170 Issued in HI
Practice address
94-1480 Moaniani St
Waipahu, HI 96797-4632
Phone
(808) 432-3100
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD15170 HI Primary
Internal Medicine Physician 207R00000X G74660 CA

Addresses

Primary practice location

94-1480 Moaniani St
Waipahu, HI 96797-4632

Mailing address

94-1480 Moaniani St
Waipahu, HI 96797-4632
Phone (808) 432-3100

Other identifiers 1

IdentifierTypeStateIssuer
00G746600MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091002000639 HI Practitioner - Internal Medicine 0648316760 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G74660CAMDInternal Medicine Physician
MD15170HIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Permanente Medical Group Inc CurrentSince Aug 31, 2009 Accepting new patients
Straub Clinic & Hospital CurrentSince Oct 23, 2017 Accepting new patients
Straub Clinic & Hospital CurrentSince Oct 23, 2017 Accepting new patients

Locations

888 S King St
Honolulu, HI 96813
Phone (808) 522-4000

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

94-1480 Moaniani St
Waipahu, HI 96797
Phone (808) 432-2000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250812800000",
    "number": "1891873675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94-1480 MOANIANI ST",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967974632",
            "telephone_number": "808-432-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94-1480 MOANIANI ST",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967974632",
            "telephone_number": "808-432-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUN",
        "first_name": "JONATHAN",
        "middle_name": "H.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2009-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MD15170",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G74660",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G746600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waipahu, HI

Sources for this page

Verify at the official NPI Registry.