Provider Demographics
NPI:1255432167
Name:SANDOR, JOHN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SANDOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:480 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:808-257-3365
Mailing Address - Fax:808-257-5653
Practice Address - Street 1:BLDG. 3089 AVE. D
Practice Address - Street 2:MARINE CORPS BASE HAWAII
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96863
Practice Address - Country:US
Practice Address - Phone:808-257-3365
Practice Address - Fax:808-257-5653
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-9892207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000211847OtherHMSA BILLING NUMBER
HI086888-02Medicaid
HIA52058Medicare UPIN
HIH50336Medicare PIN