Healthcare Provider Details

I. General information

NPI: 1497371348
Provider Name (Legal Business Name): VINSON K DIEP MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 1190
HONOLULU HI
96826-1089
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 1190
HONOLULU HI
96826-1089
US

V. Phone/Fax

Practice location:
  • Phone: 808-945-9955
  • Fax: 808-945-9988
Mailing address:
  • Phone: 808-945-9955
  • Fax: 808-945-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VINSON KIEN DIEP
Title or Position: PRESIDENT
Credential: MD
Phone: 808-227-3988