Healthcare Provider Details

I. General information

NPI: 1730561739
Provider Name (Legal Business Name): HANA PONO CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 450
HONOLULU HI
96814-1871
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 450
HONOLULU HI
96814-1871
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-6688
  • Fax:
Mailing address:
  • Phone: 808-537-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number05318
License Number StateHI

VIII. Authorized Official

Name: SPENCER CHUN
Title or Position: OWNER
Credential:
Phone: 808-537-6688