Healthcare Provider Details

I. General information

NPI: 1750635801
Provider Name (Legal Business Name): INSAF ALLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2012
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 MAIN ST
WAILUKU HI
96793-1625
US

IV. Provider business mailing address

2180 MAIN ST
WAILUKU HI
96793-1625
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-6464
  • Fax:
Mailing address:
  • Phone: 808-242-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-20897
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number052542
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-1868
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: