Healthcare Provider Details

I. General information

NPI: 1073624276
Provider Name (Legal Business Name): MICKEY M TSENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LILIHA ST SUITE #101
HONOLULU HI
96817-1650
US

IV. Provider business mailing address

2228 LILIHA ST STE 101
HONOLULU HI
96817-1651
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-5070
  • Fax: 808-531-5074
Mailing address:
  • Phone: 808-484-1169
  • Fax: 808-484-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-10396
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: