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General NPI Number Information
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NPI Number | 1841506565
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Entity Type | Organization
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Legal Business Name | ETHAN CT PIEN MD LLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 1010 S KING ST 111
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City | HONOLULU
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State | HI
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Zip | 96814-1701
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Country | US
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Telephone | 808-597-8765
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Fax | 808-597-6578
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Provider Business Mailing Address
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Address Line | 1010 S KING ST 111
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City | HONOLULU
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State | HI
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Zip | 96814-1701
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Country | US
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Telephone | 808-597-8765
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Fax | 808-597-6578
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Authorized Official
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Title or Position | OWNER
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Name | ETHAN PIEN
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Credential | M.D.
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Telephone | 808-386-1866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 14017
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License Number State | HI
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