=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972224020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN LIN PENDER RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2022
-----------------------------------------------------
Last Update Date | 04/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91-2141 FORT WEAVER RD
-----------------------------------------------------
City | EWA BEACH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96706-1993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-691-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 835 AALAPAPA DR
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-280-7884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 349-LD
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------