Basic Information
Provider Information
NPI: 1861768459
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIND
FirstName: ANGELA
MiddleName: JIMENO
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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Mailing Information
Address1: 450 KILAUEA AVE STE 105
Address2:  
City: HILO
State: HI
PostalCode: 967203089
CountryCode: US
TelephoneNumber: (808) 961-4071
FaxNumber:  
Practice Location
Address1: 1178 KINOOLE ST
Address2:  
City: HILO
State: HI
PostalCode: 967207206
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber: 8089614795
Other Information
ProviderEnumerationDate: 03/28/2012
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XMD20777MEN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XMD19201HIY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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