Healthcare Provider Details

I. General information

NPI: 1649894270
Provider Name (Legal Business Name): KEITH GUMABON SABLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

IV. Provider business mailing address

1356 LUSITANA ST FL 7
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-7657
  • Fax: 808-691-8541
Mailing address:
  • Phone: 808-586-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-23494
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: