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General NPI Number Information
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NPI Number | 1568830909
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Entity Type | Organization
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Legal Business Name | LORI TUNGPALAN-GRONDOLSKY MD, INC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 1350 PUNCHBOWL ST
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 419-230-7480
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2997
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City | HONOLULU
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State | HI
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Zip | 96802-2997
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Country | US
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Telephone | 419-230-7480
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORI TUNGPALAN-GRONDOLSKY
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Credential |
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Telephone | 419-230-7480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 14755
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License Number State | HI
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