| Roy M Koga M D Inc | |
|
670 Ponahawai St Ste 120 Hilo HI 96720-2660 | |
| (808) 961-2673 | |
| (808) 961-3051 |
| Full Name | Roy M Koga M D Inc |
|---|---|
| Speciality | General Practice |
| Location | 670 Ponahawai St Ste 120, Hilo, Hawaii |
| Authorized Official Name and Position | Roy M Koga (OWNER) |
| Authorized Official Contact | 8089612673 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roy M Koga M D Inc 670 Ponahawai St Ste 120 Hilo HI 96720-2660 Ph: (808) 961-2673 | Roy M Koga M D Inc 670 Ponahawai St Ste 120 Hilo HI 96720-2660 Ph: (808) 961-2673 |
| NPI Number | 1336318674 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 09/24/2010 |
| Medicare PECOS PAC ID | 1052437100 |
|---|---|
| Medicare Enrollment ID | O20100925000245 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336318674 | NPI | - | NPPES |
| 037014-02 | Medicaid | HI | |
| 0000040741 | Other | HI | BCBS-HMSA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | MD-2816 (Hawaii) | Primary |
| Provider Name | Roy M Koga |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1164511309 PECOS PAC ID: 2860518917 Enrollment ID: I20110201000786 |
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