Healthcare Provider Details

I. General information

NPI: 1861435901
Provider Name (Legal Business Name): LISA A CHING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 308
HONOLULU HI
96817-2360
US

IV. Provider business mailing address

1139 9TH AVE STE 110
HONOLULU HI
96816-2421
US

V. Phone/Fax

Practice location:
  • Phone: 808-383-2432
  • Fax: 808-440-6878
Mailing address:
  • Phone: 808-383-2432
  • Fax: 808-440-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-10218
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: