Healthcare Provider Details

I. General information

NPI: 1518902295
Provider Name (Legal Business Name): PANU LIMPISVASTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LILIHA STREET #701
HONOLULU HI
96817
US

IV. Provider business mailing address

1520 LILIHA STREET #701
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-4577
  • Fax: 808-528-4577
Mailing address:
  • Phone: 808-528-4577
  • Fax: 808-528-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2476
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2476
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: