Healthcare Provider Details

I. General information

NPI: 1356573083
Provider Name (Legal Business Name): PACIFIC SPORTS REHAB,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST SUITE 801
HONOLULU HI
96817-2364
US

IV. Provider business mailing address

321 N KUAKINI ST SUITE 801
HONOLULU HI
96817-2364
US

V. Phone/Fax

Practice location:
  • Phone: 808-585-7799
  • Fax: 888-417-2122
Mailing address:
  • Phone: 808-521-2002
  • Fax: 888-417-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2995
License Number StateHI

VIII. Authorized Official

Name: DR. PAUL HOWYUE WANG
Title or Position: DOCTORATE OF PHYSICAL THERAPY
Credential: DPT
Phone: 808-585-7799