Healthcare Provider Details

I. General information

NPI: 1578499000
Provider Name (Legal Business Name): GREAT LOONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 14TH AVE
HONOLULU HI
96816-3629
US

IV. Provider business mailing address

1005 14TH AVE
HONOLULU HI
96816-3629
US

V. Phone/Fax

Practice location:
  • Phone: 808-259-1866
  • Fax:
Mailing address:
  • Phone: 808-259-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: VICTOR TAN
Title or Position: ACUPUNCTURIST
Credential: L,AC
Phone: 808-259-1866