Healthcare Provider Details

I. General information

NPI: 1477984144
Provider Name (Legal Business Name): ISLAND WELLNESS & HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST DEPT RADIATION THERAPY, KUAKINI MEDICAL CENTER
HONOLULU HI
96817-2336
US

IV. Provider business mailing address

PO BOX 17624
HONOLULU HI
96817-0624
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-9548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD 15671
License Number StateHI

VIII. Authorized Official

Name: LADONNA CHUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 808-268-2828