Healthcare Provider Details

I. General information

NPI: 1215964978
Provider Name (Legal Business Name): HENRY WAH LOUIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE 205
KAILUA HI
96734-4418
US

IV. Provider business mailing address

642 ULUKAHIKI ST STE 205
KAILUA HI
96734-4418
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-3311
  • Fax: 808-536-3779
Mailing address:
  • Phone: 808-531-3311
  • Fax: 808-536-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD-13039
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: