Healthcare Provider Details

I. General information

NPI: 1417167438
Provider Name (Legal Business Name): MYA MOE HLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HLA MYA MOE MD

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 N SCHOOL ST
HONOLULU HI
96819-2539
US

IV. Provider business mailing address

625 AUWINA ST
KAILUA HI
96734-3428
US

V. Phone/Fax

Practice location:
  • Phone: 808-791-9400
  • Fax: 808-791-9456
Mailing address:
  • Phone: 808-263-0180
  • Fax: 808-843-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 14966
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: