Provider Demographics
NPI:1447209069
Name:SLOMOFF, BOYD JUSTIN (MD)
Entity type:Individual
Prefix:MR
First Name:BOYD
Middle Name:JUSTIN
Last Name:SLOMOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4348 WAIALAE #565
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-738-0501
Mailing Address - Fax:808-738-5821
Practice Address - Street 1:220 S. KING STREET
Practice Address - Street 2:SUITE #980
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-551-5168
Practice Address - Fax:808-521-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD40632084P0800X
CAG456812084P0800X
HIMD#40632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04706801Medicaid
HIHMSA-B053484OtherHMSA
HI047069801Medicaid
H4063OtherTRICARE
H4063OtherTRICARE
HIHMSA-B053484OtherHMSA