Healthcare Provider Details

I. General information

NPI: 1932583978
Provider Name (Legal Business Name): RONG RONG ENTERPRISE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 KEAHOLE STREET E211-D
HONOLULU HI
96825-0868
US

IV. Provider business mailing address

92-1001 ALIINUI DR 28C
KAPOLEI HI
96707-2250
US

V. Phone/Fax

Practice location:
  • Phone: 808-783-2468
  • Fax:
Mailing address:
  • Phone: 808-783-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DEPRY
Title or Position: CEO
Credential: PSY.D.
Phone: 808-783-2468