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General NPI Number Information
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NPI Number | 1861473233
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Entity Type | Individual
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Provider Name | BENJAMIN TIONGSON GAMBOA MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 02/20/2010
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Provider Practice Location Address
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Address Line | 135 S WAKEA AVE STE 107
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City | KAHULUI
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State | HI
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Zip | 96732-1385
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Country | US
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Telephone | 808-873-0299
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Fax | 808-873-0290
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Provider Business Mailing Address
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Address Line | 135 S WAKEA AVE STE 107
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City | KAHULUI
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State | HI
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Zip | 96732-1385
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Country | US
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Telephone | 808-873-0299
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Fax | 808-873-0290
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | HD8771
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License Number State | HI
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