Healthcare Provider Details

I. General information

NPI: 1992055321
Provider Name (Legal Business Name): EZER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 KEEAUMOKU STREET #110 A
HONOLULU HI
96814
US

IV. Provider business mailing address

655 KEEAUMOKU STREET #110 A
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-1119
  • Fax: 808-440-5458
Mailing address:
  • Phone: 808-944-1119
  • Fax: 808-440-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDIO-223
License Number StateHI

VIII. Authorized Official

Name: SU YON KIM
Title or Position: OWNER
Credential:
Phone: 808-944-1118