Healthcare Provider Details

I. General information

NPI: 1003965476
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 LILIHA ST SUITE 201
HONOLULU HI
96817-5410
US

IV. Provider business mailing address

1834 NUUANU AVE SUITE 203
HONOLULU HI
96817-2427
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-2200
  • Fax: 808-531-2202
Mailing address:
  • Phone: 808-585-7293
  • Fax: 808-585-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDELL PANG
Title or Position: VICE PRESIDENT
Credential:
Phone: 808-585-7293