Healthcare Provider Details

I. General information

NPI: 1043654015
Provider Name (Legal Business Name): JEAN PAUL COLON-PONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST STE 1007
HONOLULU HI
96813
US

IV. Provider business mailing address

1380 LUSITANA ST STE 1007A
HONOLULU HI
96813-2461
US

V. Phone/Fax

Practice location:
  • Phone: 808-748-4488
  • Fax: 808-748-4799
Mailing address:
  • Phone: 808-748-4700
  • Fax: 808-536-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD61584018
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number030043
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-19702
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: