Facts
- Status
- A
- Credential
- DO
- Type
- Individual
- Enumeration date
- 2011-07-14
- Last updated
- 2022-10-25
Specialties
Licenses
- License HI
- DOS-1508
Location
- Practice location
- 480 CENTRAL AVE
- City
- JBPHH HI
- Postal code
- 968604908
- Phone
- 808-474-4242
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.