Basic Information
| Provider Information | |||||||||
| NPI: | 1811369408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE QUEEN'S MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 N BERETANIA ST | ||||||||
| Address2: | APT 1505 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083218721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
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| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085389011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2015 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | KWOK | ||||||||
| AuthorizedOfficialFirstName: | FONG CHUN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIETITIAN | ||||||||
| AuthorizedOfficialTelephone: | 8083218721 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | R.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 86034562 | HI | Y | Hospitals | General Acute Care Hospital |
No ID Information.