Healthcare Provider Details

I. General information

NPI: 1881651271
Provider Name (Legal Business Name): JOHN LEON BOSSIAN II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15TH MDOS JBPH CIRCLE ROAD
PEARL HARBOR HI
96734
US

IV. Provider business mailing address

515 ILIAINA ST
KAILUA HI
96734-1812
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6100
  • Fax:
Mailing address:
  • Phone: 808-448-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1419
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: