Provider Demographics
NPI:1144372350
Name:GANEL, JOSE ADAN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ADAN
Last Name:GANEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:145 MAONO PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2530
Mailing Address - Country:US
Mailing Address - Phone:808-230-0824
Mailing Address - Fax:808-525-7599
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:SUITE 620
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-486-0429
Practice Address - Fax:808-525-7599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI10568207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25430801Medicaid
HIH52737Medicare ID - Type Unspecified
HI25430801Medicaid