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General NPI Number Information
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NPI Number | 1184798316
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Entity Type | Organization
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Legal Business Name | HONOLULU MEDICAL GROUP
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 550 S BERETANIA ST 4TH FLOOR
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City | HONOLULU
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State | HI
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Zip | 96813-2496
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Country | US
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Telephone | 808-537-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 550 S BERETANIA ST 4TH FLOOR
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City | HONOLULU
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State | HI
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Zip | 96813-2496
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Country | US
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Telephone | 808-537-2211
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KIM ROCHA
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Credential |
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Telephone | 808-537-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD-5757
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License Number State | HI
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