Basic Information
| Provider Information | |||||||||
| NPI: | 1457443467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GINGRICH | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082613326 | ||||||||
| FaxNumber: | 8082634604 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082613326 | ||||||||
| FaxNumber: | 8082634604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD-1864 | HI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD-1864 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | X41421 | 01 | HI | HMSA | OTHER | 037663 | 05 | HI | MEDICAID |