Healthcare Provider Details

I. General information

NPI: 1073947370
Provider Name (Legal Business Name): GLORIA KAY HAMADA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ULUNIU ST STE 412 SUITE #412
KAILUA HI
96734-2544
US

IV. Provider business mailing address

1490 HUMUWILI PL
KAILUA HI
96734-3714
US

V. Phone/Fax

Practice location:
  • Phone: 808-222-8199
  • Fax:
Mailing address:
  • Phone: 808-222-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number685
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: