Healthcare Provider Details

I. General information

NPI: 1699849034
Provider Name (Legal Business Name): GREGORY PARK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N CHURCH ST
WAILUKU HI
96793-1600
US

IV. Provider business mailing address

SEVEN WATERFRONT PLAZA 500 ALA MOANA BLVD., SUITE 300
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-7627
  • Fax: 808-243-2272
Mailing address:
  • Phone: 808-521-1317
  • Fax: 808-533-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD3915
License Number StateHI

VIII. Authorized Official

Name: DR. GREGORY PARK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-244-7627