Healthcare Provider Details

I. General information

NPI: 1710995972
Provider Name (Legal Business Name): DAVID JOSEPH HEENEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S PUUNENE AVE STE 115
KAHULUI HI
96732-2192
US

IV. Provider business mailing address

53 S PUUNENE AVE STE 115
KAHULUI HI
96732-2192
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-6402
  • Fax: 808-871-5587
Mailing address:
  • Phone: 808-877-6402
  • Fax: 808-871-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD4824
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: