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General NPI Number Information
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NPI Number | 1700035953
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Entity Type | Organization
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Legal Business Name | CHI LIFESTYLE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 934 MAUNAWILI CIR
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City | KAILUA
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State | HI
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Zip | 96734-4619
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Country | US
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Telephone | 808-261-7801
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Fax | 808-261-7725
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Provider Business Mailing Address
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Address Line | 934 MAUNAWILI CIR
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City | KAILUA
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State | HI
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Zip | 96734-4619
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Country | US
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Telephone | 808-261-7801
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Fax | 808-261-7725
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH C CHRISTENSON
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Credential | MD
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Telephone | 808-779-3985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD-12322
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License Number State | HI
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