| Doctor Name: | DR. HOMAYON M. TAVAKOLI |
| NPI Number: | 1003037052 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD-7153 |
| Business Practice Address: | 1325 S. Kihei Rd. Suite # 103 Kihei, HI - 96753 |
| Business Phone Number: | 8088797781 |
| Business Fax Number: | 8088790594 |
| Mailing Address: | 1325 S. Kihei Rd., Suite # 103 KIHEI |
| State: | HI |
| Postal Code: | 96753 |
| Phone Number: | 8088797781 |
| Fax Number: | 8088790594 |
| NPI Enumeration Date: | 05/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD-7153 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |