MEDICARE: DR. MARK K K ZEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4857	HI

General Provider Information

NPI Number	:	1730138827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK K K ZEN MD

Provider Business Mailing Address
First Line	:	PO BOX 62179
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96839-2179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 S BERETANIA STREET
Second Line	:	SUITE 302
City	:	HONOLULU
State	:	HI
Zip	:	96814-1802
Country	:	US
Telephone Number	:	808-591-6599
Fax Number	:	808-591-6075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	03/24/2008

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