MEDICARE: MR. DAVID TERRANCE REPKING IDC

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1861454712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID TERRANCE REPKING IDC

Provider Business Mailing Address
First Line	:	156 CHUNG-HOON PL
Second Line	:	102
City	:	HONOLULU
State	:	HI
Zip	:	96818-7367
Country	:	US
Telephone Number	:	808-473-1014
Fax Number	:	808-473-3109

Provider Business Practice Location Address
First Line	:	822 CLARK ST
Second Line	:	USS HONOLULU SSN718 SUITE 400
City	:	PEARL HARBOR
State	:	HI
Zip	:	96860-4652
Country	:	US
Telephone Number	:	808-474-1128
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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