Healthcare Provider Details

I. General information

NPI: 1124895438
Provider Name (Legal Business Name): VIP TRANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 KALEWA ST
HONOLULU HI
96819-1811
US

IV. Provider business mailing address

443 KALEWA ST
HONOLULU HI
96819-1811
US

V. Phone/Fax

Practice location:
  • Phone: 808-836-3391
  • Fax: 808-836-4614
Mailing address:
  • Phone: 808-836-3391
  • Fax: 808-836-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: RICHARD QUINTAL
Title or Position: MANAGER
Credential:
Phone: 808-836-3391