Healthcare Provider Details

I. General information

NPI: 1972467579
Provider Name (Legal Business Name): WEYMOUTH SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 RICE ST STE 2018
LIHUE HI
96766-1764
US

IV. Provider business mailing address

3501 RICE ST STE 2018
LIHUE HI
96766-1764
US

V. Phone/Fax

Practice location:
  • Phone: 808-211-2700
  • Fax:
Mailing address:
  • Phone: 808-211-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WEYMOUTH
Title or Position: OWNER
Credential: DO
Phone: 808-212-7007