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General NPI Number Information
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NPI Number | 1871916767
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Entity Type | Organization
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Legal Business Name | ISLAND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 615 PIIKOI ST SUITE 1601
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City | HONOLULU
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State | HI
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Zip | 96814-3116
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Country | US
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Telephone | 808-589-1955
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Fax | 808-589-1712
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Provider Business Mailing Address
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Address Line | 615 PIIKOI STREET SUITE 1601
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City | HONOLULU
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State | HI
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Zip | 96814
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Country | US
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Telephone | 808-589-1955
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Fax | 808-589-1712
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON YOSHIO UCHIDA
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Credential | N.D.
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Telephone | 808-589-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ND-0082
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License Number State | HI
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