Healthcare Provider Details

I. General information

NPI: 1245032770
Provider Name (Legal Business Name): SISSI CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

221 MAHALANI ST # 24
WAILUKU HI
96793-2526
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-9056
  • Fax:
Mailing address:
  • Phone: 808-244-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD-25380
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: