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General NPI Number Information
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NPI Number | 1205427861
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Entity Type | Organization
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Legal Business Name | IVEY PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 411 HUKU LII PL STE 303
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City | KIHEI
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State | HI
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Zip | 96753-7062
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Country | US
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Telephone | 808-877-7710
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Fax | 808-877-7480
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Provider Business Mailing Address
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Address Line | LOCKBOX 5799 PO BOX 31000
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City | HONOLULU
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State | HI
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Zip | 96849-5799
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Country | US
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Telephone | 808-877-7710
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Fax | 808-877-7480
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JON S IVEY
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Credential | MD
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Telephone | 843-830-6479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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