Healthcare Provider Details

I. General information

NPI: 1407671902
Provider Name (Legal Business Name): JUN GERMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1440 18TH AVENUE
KEA'AU HI
96749
US

IV. Provider business mailing address

PO BOX 23
MOUNTAIN VIEW HI
96771-0023
US

V. Phone/Fax

Practice location:
  • Phone: 808-968-9700
  • Fax: 808-968-2714
Mailing address:
  • Phone: 808-825-0932
  • Fax: 808-968-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number2-240071
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: