Basic Information
| Provider Information | |||||||||
| NPI: | 1538562327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | #411 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082637203 | ||||||||
| FaxNumber: | 8082634604 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | #411 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082637203 | ||||||||
| FaxNumber: | 8082634604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | AMD-580 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.