Healthcare Provider Details

I. General information

NPI: 1013571546
Provider Name (Legal Business Name): JENNY LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-4970
  • Fax: 808-691-5075
Mailing address:
  • Phone: 808-691-4970
  • Fax: 808-691-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD22312
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: