Healthcare Provider Details

I. General information

NPI: 1871554105
Provider Name (Legal Business Name): PON-SANG CHAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 704
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

321 N KUAKINI ST STE 704
HONOLULU HI
96817-2362
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-2118
  • Fax: 808-593-0922
Mailing address:
  • Phone: 808-591-2118
  • Fax: 808-593-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD 4414
License Number StateHI

VIII. Authorized Official

Name: DR. PON-SANG CHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-591-2118