Provider Demographics
NPI:1447326947
Name:NATHAN, JEFFREY H (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:NATHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 22877
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823
Mailing Address - Country:US
Mailing Address - Phone:808-944-1133
Mailing Address - Fax:
Practice Address - Street 1:1585 KAPIOLANI BLVD. #1234
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-944-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI502402-01Medicaid
HI51596Medicare ID - Type Unspecified
HI502402-01Medicaid