Healthcare Provider Details

I. General information

NPI: 1184364119
Provider Name (Legal Business Name): NICHOLAS SIMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2141 FORT WEAVER RD
EWA BEACH HI
96706-1993
US

IV. Provider business mailing address

770 KAPIOLANI BLVD STE 705
HONOLULU HI
96813-5241
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-3000
  • Fax:
Mailing address:
  • Phone: 808-587-8778
  • Fax: 808-597-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-26599
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: