Provider Demographics
NPI:1881696854
Name:MEDICAL ARTS CLINIC INC
Entity type:Organization
Organization Name:MEDICAL ARTS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABUNDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:808-622-1618
Mailing Address - Street 1:302 CALIFORNIA AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-622-1618
Mailing Address - Fax:808-622-3083
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:STE 106
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-622-1618
Practice Address - Fax:808-622-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-1350207Q00000X
HIMD-12381207Q00000X
HIMD-1027207Q00000X
HIMD-1282207R00000X, 208600000X
HIMD-9483207R00000X
HIMD-9705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMAC001Medicare ID - Type Unspecified