Healthcare Provider Details

I. General information

NPI: 1043567225
Provider Name (Legal Business Name): AMENDEEP SOMAL, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N KUAKINI ST
HONOLULU HI
96817-2488
US

IV. Provider business mailing address

226 N KUAKINI ST
HONOLULU HI
96817-2488
US

V. Phone/Fax

Practice location:
  • Phone: 808-566-3460
  • Fax: 808-535-1572
Mailing address:
  • Phone: 808-566-3460
  • Fax: 808-535-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13067
License Number StateHI

VIII. Authorized Official

Name: LOVEY SODERBERG
Title or Position: OFFICE MANAGER
Credential:
Phone: 808-566-3460