Unknown Individual – Procedural Dermatology Physician, NPI 1225069990

Unknown Individual is a healthcare provider. based in Honolulu, Hawaii. specializing in Procedural Dermatology Physician. They hold a License No. 3540 (HI). The NPI Number for Unknown Individual is 1225069990

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1225069990
Phone
(808) 596-0955
Address
1150 S KING ST
Deactivation Date
28 August 2025

Doctor Profile

Medical School Name
WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1972 (54 years ago)
PAC ID
4880584580
Professional Enrollment ID
I20120201000497
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Atlas Insurance Building, 1150, South King Street, Makiki Kai, Honolulu, Honolulu County, Hawaii, 96814, United States

    SUITE 201

    HONOLULU, HI 968141922

    Phone: (808) 596-0955

    Fax: (808) 593-9656

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 96814)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1225069990 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Procedural Dermatology Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Honolulu?
Public fields place Unknown Individual around Honolulu, Hawaii. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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