Healthcare Provider Details

I. General information

NPI: 1275822066
Provider Name (Legal Business Name): AMY LUMENG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST SUITE 1103
HONOLULU HI
96817-6300
US

IV. Provider business mailing address

909 KAPIOLANI BLVD APARTMENT 2707
HONOLULU HI
96814-2199
US

V. Phone/Fax

Practice location:
  • Phone: 808-778-5438
  • Fax: 808-440-2255
Mailing address:
  • Phone: 808-778-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-11345
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-11345
License Number StateHI

VIII. Authorized Official

Name: DR. AMY F. LUMENG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-778-5438