Healthcare Provider Details

I. General information

NPI: 1962940965
Provider Name (Legal Business Name): HONOLULU WELLNESS GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST STE 1655
HONOLULU HI
96814-1950
US

IV. Provider business mailing address

1314 S KING ST STE 1654
HONOLULU HI
96814-1950
US

V. Phone/Fax

Practice location:
  • Phone: 808-924-7246
  • Fax: 833-849-4198
Mailing address:
  • Phone: 808-924-7246
  • Fax: 833-849-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACIE ASAYAMA
Title or Position: PRESIDENT
Credential:
Phone: 808-591-9339