Healthcare Provider Details

I. General information

NPI: 1982795118
Provider Name (Legal Business Name): CHARLES ANTHONY SOMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E LIPOA ST UNIT 4106
KIHEI HI
96753-5821
US

IV. Provider business mailing address

30 E LIPOA ST UNIT 4106
KIHEI HI
96753-5821
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-0001
  • Fax: 808-244-6746
Mailing address:
  • Phone: 808-242-0001
  • Fax: 808-244-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number20-2598134
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: