Healthcare Provider Details

I. General information

NPI: 1396203295
Provider Name (Legal Business Name): THE MOSES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 322
AIEA HI
96701-5301
US

IV. Provider business mailing address

98-1247 KAAHUMANU ST STE 116
AIEA HI
96701-5300
US

V. Phone/Fax

Practice location:
  • Phone: 808-782-1113
  • Fax: 808-356-0966
Mailing address:
  • Phone: 808-762-0911
  • Fax: 808-299-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN PAUL MOSES III
Title or Position: MANAGING PARTNER
Credential: APRN
Phone: 808-762-0911