Healthcare Provider Details

I. General information

NPI: 1194263558
Provider Name (Legal Business Name): ALOHAENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1035 MAMALAHOA HWY STE K
KAMUELA HI
96743-8440
US

IV. Provider business mailing address

64-1035 MAMALAHOA HWY STE K
KAMUELA HI
96743-8440
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-0706
  • Fax: 808-887-1878
Mailing address:
  • Phone: 808-887-0706
  • Fax: 808-887-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD 18946
License Number StateHI

VIII. Authorized Official

Name: DR. JOHN D STOVER
Title or Position: CONTRACTED ENTITY
Credential: MD
Phone: 808-960-5412