Healthcare Provider Details

I. General information

NPI: 1134231095
Provider Name (Legal Business Name): HEATH H CHUNG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

PO BOX 37056
HONOLULU HI
96837-0056
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-7111
  • Fax: 808-528-5507
Mailing address:
  • Phone: 808-225-0263
  • Fax: 808-528-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13906
License Number StateHI

VIII. Authorized Official

Name: HEATH H CHUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-225-5432