Healthcare Provider Details

I. General information

NPI: 1891136032
Provider Name (Legal Business Name): MARY TANG LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-408 AKOKI ST SUITE 202
WAIPAHU HI
96797-2733
US

IV. Provider business mailing address

94-408 AKOKI ST SUITE 202
WAIPAHU HI
96797-2733
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-5584
  • Fax: 808-676-5587
Mailing address:
  • Phone: 808-676-5584
  • Fax: 808-676-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-2058
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: