=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063710531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAN KWOK, D.O., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2011
-----------------------------------------------------
Last Update Date | 03/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 WARD AVE STE 700
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-544-2645
-----------------------------------------------------
Fax | 808-441-1706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 WARD AVE STE 700
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-544-2645
-----------------------------------------------------
Fax | 808-441-1706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. DAN KWOK
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 808-544-2645
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------