Healthcare Provider Details

I. General information

NPI: 1639552599
Provider Name (Legal Business Name): KAMONKIAT WIRUNSAWANYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3097
US

IV. Provider business mailing address

888 S KING ST
HONOLULU HI
96813-3097
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4344
  • Fax: 808-522-3336
Mailing address:
  • Phone: 808-522-4344
  • Fax: 808-522-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD-21031
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: