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General NPI Number Information
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NPI Number | 1801041801
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Entity Type | Individual
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Provider Name | ETHAN LUM A.T.C
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Gender | Male
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 3142 WAIALAE AVE
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City | HONOLULU
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State | HI
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Zip | 96816-1510
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Country | US
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Telephone | 808-739-4824
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Fax |
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Provider Business Mailing Address
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Address Line | 98-149 PUAALII ST
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City | AIEA
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State | HI
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Zip | 96701-2205
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Country | US
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Telephone | 808-780-1564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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