Healthcare Provider Details

I. General information

NPI: 1194415935
Provider Name (Legal Business Name): SOMA CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 KALAKAUA AVE STE 112
HONOLULU HI
96815-2354
US

IV. Provider business mailing address

2155 KALAKAUA AVE STE 112
HONOLULU HI
96815-2354
US

V. Phone/Fax

Practice location:
  • Phone: 808-358-2182
  • Fax: 808-900-5797
Mailing address:
  • Phone: 808-358-2182
  • Fax: 808-900-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. YOICHI SOMA
Title or Position: MEMBER
Credential: MD
Phone: 808-722-4135