Healthcare Provider Details

I. General information

NPI: 1669831913
Provider Name (Legal Business Name): HAWAII METABOLIC MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVE SUITE C-316
KAILUA HI
96734-1866
US

IV. Provider business mailing address

970 N KALAHEO AVE SUITE C-316
KAILUA HI
96734-1866
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-5555
  • Fax: 808-356-0664
Mailing address:
  • Phone: 808-488-5555
  • Fax: 808-356-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateHI

VIII. Authorized Official

Name: STEPHEN WELLS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-488-5555