Healthcare Provider Details

I. General information

NPI: 1043909799
Provider Name (Legal Business Name): BENJAMIN GANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
HONOLULU HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
HONOLULU HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-9728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDOS-2608
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: