Healthcare Provider Details

I. General information

NPI: 1558744169
Provider Name (Legal Business Name): MR. GLEN JALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 WAIALAE AVE SUITE 345
HONOLULU HI
96816-5842
US

IV. Provider business mailing address

3221 WAIALAE AVE SUITE 345
HONOLULU HI
96816-5842
US

V. Phone/Fax

Practice location:
  • Phone: 808-732-5223
  • Fax:
Mailing address:
  • Phone: 808-732-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number102
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: