Healthcare Provider Details

I. General information

NPI: 1184972796
Provider Name (Legal Business Name): JOYCE FREDA JUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
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

2102 MCKINLEY STREET
HONOLULU HI
96822
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-5584
  • Fax: 808-676-5587
Mailing address:
  • Phone: 808-546-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1246
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: