MEDICARE: CARLY AKEMI WACHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A139166	CA
2	207L00000X	Anesthesiology Physician	MD-19516	HI

General Provider Information

NPI Number	:	1841646312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY AKEMI WACHI M.D.

Provider Business Mailing Address
First Line	:	4348 WAIALAE AVE # 788
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5767
Country	:	US
Telephone Number	:	808-554-5470
Fax Number	:

Provider Business Practice Location Address
First Line	:	4348 WAIALAE AVE # 788
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5767
Country	:	US
Telephone Number	:	808-554-5470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	01/26/2023

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