Provider Demographics
NPI:1548435787
Name:SUGAI, WESLEY JITSUO (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JITSUO
Last Name:SUGAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:78-6831 ALII DR STE 328
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-4408
Mailing Address - Country:US
Mailing Address - Phone:808-329-7719
Mailing Address - Fax:808-329-7518
Practice Address - Street 1:78-6831 ALII DR STE 328
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-4408
Practice Address - Country:US
Practice Address - Phone:808-329-7719
Practice Address - Fax:808-329-7518
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI5336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI022065Medicaid