Healthcare Provider Details

I. General information

NPI: 1891441382
Provider Name (Legal Business Name): QUEENS UNIVERSITY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-1000
  • Fax: 808-691-4646
Mailing address:
  • Phone: 808-691-1000
  • Fax: 808-691-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TRACI K KOBAYASHI
Title or Position: TREASURER
Credential:
Phone: 808-691-7795