Healthcare Provider Details

I. General information

NPI: 1255942678
Provider Name (Legal Business Name): ALOHA UROLOGY WEST OAHU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 406
HONOLULU HI
96813-2412
US

IV. Provider business mailing address

1329 LUSITANA ST STE 406
HONOLULU HI
96813-2412
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-7779
  • Fax: 808-599-7780
Mailing address:
  • Phone: 808-599-7779
  • Fax: 808-599-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMUR M ROYTMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 808-777-4176