Healthcare Provider Details

I. General information

NPI: 1679667190
Provider Name (Legal Business Name): JOSEPH A D'ANGELO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 KILAUEA AVE STE 103
HILO HI
96720-3084
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1753
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-3600
  • Fax: 808-933-2983
Mailing address:
  • Phone: 808-333-3600
  • Fax: 808-961-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD-8588
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: