Healthcare Provider Details

I. General information

NPI: 1922696962
Provider Name (Legal Business Name): NINA TATIANA HAMID DACM, L.AC, MAC.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5995 KUAKINI HWY STE 445
KAILUA KONA HI
96740-2123
US

IV. Provider business mailing address

73-4435 PAIAHA ST
KAILUA KONA HI
96740-9316
US

V. Phone/Fax

Practice location:
  • Phone: 808-638-3343
  • Fax: 844-308-3545
Mailing address:
  • Phone: 808-640-8926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1310
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: