Healthcare Provider Details

I. General information

NPI: 1174589014
Provider Name (Legal Business Name): WAHIAWA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-390 KUAHELANI AVE
MILILANI HI
96789-1192
US

IV. Provider business mailing address

128 LEHUA ST
WAHIAWA HI
96786-2036
US

V. Phone/Fax

Practice location:
  • Phone: 808-627-3200
  • Fax:
Mailing address:
  • Phone: 808-621-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT D. OLDEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-621-8411