Healthcare Provider Details

I. General information

NPI: 1043657141
Provider Name (Legal Business Name): ALOHA WOUND CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

PO BOX 31000 MAIL CODE 5762
HONOLULU HI
96849-5762
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-9011
  • Fax:
Mailing address:
  • Phone: 425-656-7366
  • Fax: 425-656-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number15588
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15588
License Number StateHI

VIII. Authorized Official

Name: DR. MICHAEL S SHIN
Title or Position: PRESIDENT
Credential: M.D..
Phone: 619-258-6200