Healthcare Provider Details

I. General information

NPI: 1245289933
Provider Name (Legal Business Name): HEAJUNG RUESING MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 ULULANI ST #108
HILO HI
96720-3913
US

IV. Provider business mailing address

868 ULULANI ST #108
HILO HI
96720-3913
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-2389
  • Fax: 808-935-5109
Mailing address:
  • Phone: 808-935-2389
  • Fax: 808-935-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD7563
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD7563
License Number StateHI

VIII. Authorized Official

Name: HEAJUNG RUESING
Title or Position: PRESIDENT
Credential: MD
Phone: 808-935-2389