=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144656075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PJ HUONKER MD CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2013
-----------------------------------------------------
Last Update Date | 01/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 PUNCHBOWL ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-847-5385
-----------------------------------------------------
Fax | 808-847-5387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 235149
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96823-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-847-5385
-----------------------------------------------------
Fax | 808-847-5387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PETER JOHN HUONKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-847-5385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------