Healthcare Provider Details

I. General information

NPI: 1235549056
Provider Name (Legal Business Name): HAWAII PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 KUALA ST SUITE 102A
PEARL CITY HI
96782-3900
US

IV. Provider business mailing address

1245 KUALA ST SUITE 102A
PEARL CITY HI
96782-3900
US

V. Phone/Fax

Practice location:
  • Phone: 808-726-2161
  • Fax: 808-726-2161
Mailing address:
  • Phone: 808-726-2161
  • Fax: 808-726-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO-196
License Number StateHI

VIII. Authorized Official

Name: DR. LIANE J WATANABE
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 808-726-2161