Healthcare Provider Details

I. General information

NPI: 1912057100
Provider Name (Legal Business Name): HONOLULU PAIN MANAGEMENT CLINIC, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 1-302
HONOLULU HI
96813-4920
US

IV. Provider business mailing address

500 ALA MOANA BLVD STE 1-302
HONOLULU HI
96813-4920
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-3657
  • Fax: 808-524-6552
Mailing address:
  • Phone: 808-528-3657
  • Fax: 808-524-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD7531
License Number StateHI

VIII. Authorized Official

Name: DR. JEFFREY SZE-CHUNG WANG
Title or Position: MEMBER
Credential: M.D.
Phone: 808-528-3657