Healthcare Provider Details

I. General information

NPI: 1649463639
Provider Name (Legal Business Name): HAWAII ENDOCRINE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 N CHURCH ST SUITE 403
WAILUKU HI
96793-1680
US

IV. Provider business mailing address

415 DAIRY RD SUITE E-438
KAHULUI HI
96732-2312
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-5856
  • Fax: 808-242-5949
Mailing address:
  • Phone: 808-242-5856
  • Fax: 808-242-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number6493
License Number StateHI

VIII. Authorized Official

Name: DR. TII PETER HANSEN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 808-242-5856