Healthcare Provider Details

I. General information

NPI: 1811303605
Provider Name (Legal Business Name): EUGENE LAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
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

95-390 KUAHELANI AVE
MILILANI HI
96789-1192
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR6705
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: