Healthcare Provider Details

I. General information

NPI: 1003242637
Provider Name (Legal Business Name): EMILY DIEP, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2013
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST SUITE NUMBER 715
HONOLULU HI
96817-2364
US

IV. Provider business mailing address

321 N KUAKINI ST SUITE NUMBER 715
HONOLULU HI
96817-2364
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-6461
  • Fax: 808-550-0466
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15556
License Number StateHI

VIII. Authorized Official

Name: EMILY DIEP
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 808-523-6461