Healthcare Provider Details

I. General information

NPI: 1235941881
Provider Name (Legal Business Name): EXCEL DERMATOLOGY OF HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 4-470
HONOLULU HI
96813-4925
US

IV. Provider business mailing address

500 ALA MOANA BLVD BLDG 4, STE 470
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-495-0906
  • Fax: 808-495-4849
Mailing address:
  • Phone: 808-495-0906
  • Fax: 808-495-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IRIS KIMHAYOUNG NOH
Title or Position: OWNER
Credential:
Phone: 808-495-0906