Healthcare Provider Details

I. General information

NPI: 1356785547
Provider Name (Legal Business Name): VINCENT J. NIP, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 808
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1380 LUSITANA STREET #808
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-538-1050
  • Fax: 808-538-0108
Mailing address:
  • Phone: 808-538-1050
  • Fax: 808-538-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number5596
License Number StateHI

VIII. Authorized Official

Name: VINCENT J NIP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-538-1050