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General NPI Number Information
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NPI Number | 1295341550
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Entity Type | Organization
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Legal Business Name | CANYON PRIMARY CARE LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 328 ULUNIU ST STE 103
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City | KAILUA
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State | HI
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Zip | 96734-2542
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Country | US
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Telephone | 808-263-3020
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Fax | 808-762-1586
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Provider Business Mailing Address
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Address Line | 328 ULUNIU ST STE 103
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City | KAILUA
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State | HI
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Zip | 96734-2542
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH CANYON
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Credential | MD
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Telephone | 808-679-8518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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