Healthcare Provider Details

I. General information

NPI: 1861454712
Provider Name (Legal Business Name): DAVID TERRANCE REPKING IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 CLARK ST USS HONOLULU SSN718 SUITE 400
PEARL HARBOR HI
96860-4652
US

IV. Provider business mailing address

156 CHUNG-HOON PL 102
HONOLULU HI
96818-7367
US

V. Phone/Fax

Practice location:
  • Phone: 808-474-1128
  • Fax:
Mailing address:
  • Phone: 808-473-1014
  • Fax: 808-473-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: