Healthcare Provider Details

I. General information

NPI: 1629143573
Provider Name (Legal Business Name): CHILDREN'S ORTHOPAEDICS OF HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 122
AIEA HI
96701-5300
US

IV. Provider business mailing address

98-1247 KAAHUMANU ST STE 122
AIEA HI
96701-5300
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-8985
  • Fax: 808-485-8986
Mailing address:
  • Phone: 808-485-8985
  • Fax: 808-485-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BYRON IZUKA
Title or Position: MD
Credential: MD
Phone: 808-485-8985