Healthcare Provider Details

I. General information

NPI: 1114768546
Provider Name (Legal Business Name): SOLOMON ZOSIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73-4438 NEHIWA ST
KAILUA KONA HI
96740-9319
US

IV. Provider business mailing address

73-4438 NEHIWA ST
KAILUA KONA HI
96740-9319
US

V. Phone/Fax

Practice location:
  • Phone: 808-765-9965
  • Fax:
Mailing address:
  • Phone: 808-765-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberH01215780
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: