Basic Information
| Provider Information | |||||||||
| NPI: | 1710995972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEENEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 S PUUNENE AVE STE 115 | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967322192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088776402 | ||||||||
| FaxNumber: | 8088715587 | ||||||||
| Practice Location | |||||||||
| Address1: | 53 S PUUNENE AVE STE 115 | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967322192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088776402 | ||||||||
| FaxNumber: | 8088715587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 04/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD4824 | HI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 014640 | 05 | HI | MEDICAID |