Healthcare Provider Details

I. General information

NPI: 1467692731
Provider Name (Legal Business Name): CLINICAL DIAGNOSTIC PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 LILIHA ST #302
HONOLULU HI
96817-1600
US

IV. Provider business mailing address

1834 NUUANU AVE #203
HONOLULU HI
96817-2427
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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