Healthcare Provider Details

I. General information

NPI: 1649802505
Provider Name (Legal Business Name): AGNES OHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2020
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 KALAKAUA AVE APT 808
HONOLULU HI
96826-3725
US

IV. Provider business mailing address

1750 KALAKAUA AVE APT 808
HONOLULU HI
96826-3725
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-0404
  • Fax: 808-944-0404
Mailing address:
  • Phone: 808-944-0404
  • Fax: 808-944-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number430
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: