Healthcare Provider Details

I. General information

NPI: 1164653077
Provider Name (Legal Business Name): HAWAII EAR CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 502
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 502
HONOLULU HI
96813-2449
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-0711
  • Fax: 808-538-6763
Mailing address:
  • Phone: 808-533-0711
  • Fax: 808-538-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD14172
License Number StateHI

VIII. Authorized Official

Name: DR. KEVIN S HADLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-533-0711