Healthcare Provider Details

I. General information

NPI: 1104481423
Provider Name (Legal Business Name): HAYK GHUKASYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 LUSITANA ST # 705
HONOLULU HI
96813-2409
US

IV. Provider business mailing address

1356 LUSITANA ST # 705
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-2898
  • Fax: 808-586-7486
Mailing address:
  • Phone: 808-586-2898
  • Fax: 808-586-7486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR-7692
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: