Healthcare Provider Details

I. General information

NPI: 1568966489
Provider Name (Legal Business Name): HAWAII HOMELESS HEALTHCARE HUI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SUMNER ST
HONOLULU HI
96817-5088
US

IV. Provider business mailing address

1301 PUNCHBOWL STREET CLARK APT 406
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-447-2924
  • Fax:
Mailing address:
  • Phone: 808-691-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDY MOUNTHONGDY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-691-5309