Healthcare Provider Details

I. General information

NPI: 1295142453
Provider Name (Legal Business Name): ZACHARY LONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ALA MOANA BLVD FL 4
HONOLULU HI
96814-4200
US

IV. Provider business mailing address

1330 ALA MOANA BLVD FL 4
HONOLULU HI
96814-4200
US

V. Phone/Fax

Practice location:
  • Phone: 808-585-8855
  • Fax:
Mailing address:
  • Phone: 808-585-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number282554
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberDR.0072833
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberDOS-2075
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: