Basic Information
| Provider Information | |||||||||
| NPI: | 1700273554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGHA | ||||||||
| FirstName: | WESAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77-6431 KILOHANA ST | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967407900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039466120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 79-1019 HAUKAPILA ST | ||||||||
| Address2: | |||||||||
| City: | KEALAKEKUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967507920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083229311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1988 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DOS-1988 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.