Healthcare Provider Details

I. General information

NPI: 1437560174
Provider Name (Legal Business Name): MARY LI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NUUANU AVE STE 104
HONOLULU HI
96817-5116
US

IV. Provider business mailing address

1121 NUUANU AVE STE 104
HONOLULU HI
96817-5116
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-1133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number14584
License Number StateHI

VIII. Authorized Official

Name: DR. MARY LI
Title or Position: DIRECTOR
Credential: MD
Phone: 808-537-1133