Healthcare Provider Details

I. General information

NPI: 1811095110
Provider Name (Legal Business Name): PRAPHAN PUAPONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 OMEA PL
HONOLULU HI
96821-2618
US

IV. Provider business mailing address

2062 OMEA PL
HONOLULU HI
96821-2618
US

V. Phone/Fax

Practice location:
  • Phone: 808-728-9855
  • Fax:
Mailing address:
  • Phone: 808-373-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number3195
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: