Healthcare Provider Details

I. General information

NPI: 1841506565
Provider Name (Legal Business Name): ETHAN CT PIEN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S KING ST 111
HONOLULU HI
96814-1701
US

IV. Provider business mailing address

1010 S KING ST 111
HONOLULU HI
96814-1701
US

V. Phone/Fax

Practice location:
  • Phone: 808-597-8765
  • Fax: 808-597-6578
Mailing address:
  • Phone: 808-597-8765
  • Fax: 808-597-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number14017
License Number StateHI

VIII. Authorized Official

Name: ETHAN PIEN
Title or Position: OWNER
Credential: M.D.
Phone: 808-386-1866