Basic Information
| Provider Information | |||||||||
| NPI: | 1609519719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HONOLULU PHYSICIAN ALLIANCE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12176 | ||||||||
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| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968281176 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 347 N KUAKINI ST | ||||||||
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| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082217083 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2022 | ||||||||
| LastUpdateDate: | 04/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHIMAMOTO | ||||||||
| AuthorizedOfficialFirstName: | ROYCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8082217083 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.