Healthcare Provider Details

I. General information

NPI: 1568627909
Provider Name (Legal Business Name): MAGDY METTIAS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-300 FARRINGTON HWY # E6
WAIPAHU HI
96797-2699
US

IV. Provider business mailing address

94-300 FARRINGTON HWY # E6
WAIPAHU HI
96797-2699
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-1988
  • Fax: 808-677-0555
Mailing address:
  • Phone: 808-671-1988
  • Fax: 808-677-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number7466
License Number StateHI

VIII. Authorized Official

Name: DR. MAGDY A METTIAS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 808-671-1988