Basic Information
| Provider Information | |||||||||
| NPI: | 1063836955 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LORI TUNGPALAN-GRONDOLSKY, MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1329 LUSITANA ST | ||||||||
| Address2: | SUITE 604 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085311116 | ||||||||
| FaxNumber: | 8085247911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1329 LUSITANA ST | ||||||||
| Address2: | SUITE 604 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085311116 | ||||||||
| FaxNumber: | 8085247911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 02/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | TUNGPALAN-GRONDOLSKY | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8085311116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD - 14755 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.