Healthcare Provider Details

I. General information

NPI: 1144587361
Provider Name (Legal Business Name): OHANA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E 2ND ST
SCOTCH PLAINS NJ
07076-1751
US

IV. Provider business mailing address

1818 E 2ND ST
SCOTCH PLAINS NJ
07076-1751
US

V. Phone/Fax

Practice location:
  • Phone: 908-322-2490
  • Fax: 908-322-1381
Mailing address:
  • Phone: 908-322-2490
  • Fax: 908-322-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06866200
License Number StateNJ

VIII. Authorized Official

Name: DARREN CHIN
Title or Position: OWNER
Credential: MD
Phone: 908-322-2490