Healthcare Provider Details

I. General information

NPI: 1023016383
Provider Name (Legal Business Name): DENNY L BALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

1380 LUSITANA ST SUITE 1002
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 1002
HONOLULU HI
96813-2449
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-7402
  • Fax: 808-537-2094
Mailing address:
  • Phone: 808-521-7402
  • Fax: 808-537-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD4933
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: