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General NPI Number Information
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NPI Number | 1154064855
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Entity Type | Organization
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Legal Business Name | MI-HEALTH LLC
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 770 KAPIOLANI BLVD STE 114
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City | HONOLULU
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State | HI
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Zip | 96813-5254
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Country | US
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Telephone | 808-666-9960
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Fax | 808-666-9356
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Provider Business Mailing Address
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Address Line | 770 KAPIOLANI BLVD STE 114
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City | HONOLULU
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State | HI
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Zip | 96813-5254
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Country | US
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Telephone | 808-666-9960
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DAVID SU
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Credential |
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Telephone | 808-931-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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