Healthcare Provider Details

I. General information

NPI: 1871687657
Provider Name (Legal Business Name): ISAAC WHITE JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5995 KUAKINI HWY STE #413 DEPT OF VETERANS AFFAIRS
KAILUA-KONA HI
96740
US

IV. Provider business mailing address

73-1052 AHIKAWA STREET
KAILUA-KONA HI
96740
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-0774
  • Fax: 808-329-0776
Mailing address:
  • Phone: 808-325-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW1258
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: