Provider Demographics
NPI:1700886033
Name:COGAN, JOHN J (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:COGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 707
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-536-7327
Mailing Address - Fax:808-536-2513
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 707
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-536-7327
Practice Address - Fax:808-536-2513
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI03361207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI039412-01Medicaid
04321-6OtherHMSA
000054321-6OtherHMSA QUEST
MD3361OtherQHCP
03941201OtherALOHACARE
C98399Medicare UPIN
H55217Medicare ID - Type Unspecified
H55216Medicare ID - Type Unspecified