Healthcare Provider Details

I. General information

NPI: 1063782860
Provider Name (Legal Business Name): AJAY BHATT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

1909 ALA WAI BLVD APT 1309
HONOLULU HI
96815-1805
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9363
  • Fax:
Mailing address:
  • Phone: 847-971-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD15695
License Number StateHI

VIII. Authorized Official

Name: AJAY BHATT
Title or Position: OWNER
Credential: MD
Phone: 847-971-0510