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General NPI Number Information
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NPI Number | 1477741858
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Entity Type | Organization
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Legal Business Name | CLARA PH YONG MD INC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 30 AULIKE ST. SUITE 405
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City | KAILUA
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State | HI
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Zip | 96734-2751
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Country | US
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Telephone | 808-263-7411
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Fax | 808-263-7455
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Provider Business Mailing Address
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Address Line | 30 AULIKE ST. SUITE 405
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City | KAILUA
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State | HI
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Zip | 96734-2751
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Country | US
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Telephone | 808-263-7411
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Fax | 808-263-7455
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARA PH YONG
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Credential | M.D.
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Telephone | 808-263-7411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8072
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License Number State | HI
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