Healthcare Provider Details

I. General information

NPI: 1801946819
Provider Name (Legal Business Name): EAR, NOSE & THROAT CLINICS OF OAHU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 660
AIEA HI
96701-4721
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 660
AIEA HI
96701-4721
US

V. Phone/Fax

Practice location:
  • Phone: 808-622-2626
  • Fax: 808-622-0066
Mailing address:
  • Phone: 808-622-2626
  • Fax: 808-622-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD13392
License Number StateHI

VIII. Authorized Official

Name: DR. CHRISTOPHER REGALA
Title or Position: OWNER
Credential: M.D.
Phone: 808-622-2626