Healthcare Provider Details

I. General information

NPI: 1750421723
Provider Name (Legal Business Name): ALA ELDIN TAHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-710 KEAAHA ROAD HAWAII STATE HOSPITAL
KANEOHE HI
96744
US

IV. Provider business mailing address

1700 ALA MOANA BLVD APT 3503
HONOLULU HI
96815-1478
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2191
  • Fax:
Mailing address:
  • Phone: 609-606-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA057422
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: