Healthcare Provider Details

I. General information

NPI: 1083167472
Provider Name (Legal Business Name): HEZHI GAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

842 8TH AVE
HONOLULU HI
96816-2175
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-1000
  • Fax:
Mailing address:
  • Phone: 808-679-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD18746
License Number StateHI

VIII. Authorized Official

Name: HEZHI GAN
Title or Position: PRESIDENT
Credential: MD
Phone: 808-679-7468