Provider Demographics
NPI:1730540659
Name:MANDICH, MINDY LIN (DO)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LIN
Last Name:MANDICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 S KUKUI ST STE C108
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2328
Mailing Address - Country:US
Mailing Address - Phone:808-727-1081
Mailing Address - Fax:612-421-0028
Practice Address - Street 1:55 S KUKUI ST STE C108
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2328
Practice Address - Country:US
Practice Address - Phone:808-531-8874
Practice Address - Fax:808-523-0466
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDOS1965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine