Healthcare Provider Details

I. General information

NPI: 1336465590
Provider Name (Legal Business Name): SOPHIA B. E. HUFNAGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA BOUS MD

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 PAA ST
HONOLULU HI
96819-4430
US

IV. Provider business mailing address

2828 PAA ST
HONOLULU HI
96819-4430
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-5700
  • Fax:
Mailing address:
  • Phone: 808-432-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD043297
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD-23481
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: