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General NPI Number Information
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NPI Number | 1104967876
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Entity Type | Individual
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Provider Name | BENNY K.P. FAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 305 ROYAL HAWAIIAN AVE SUITE307
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City | HONOLULU
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State | HI
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Zip | 96815-2526
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Country | US
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Telephone | 808-924-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 AALA ST APT#1203
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City | HONOLULU
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State | HI
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Zip | 96817-3604
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Country | US
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Telephone | 808-537-1416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 23
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License Number State | HI
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