Basic Information
| Provider Information | |||||||||
| NPI: | 1821565797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86-260 FARRINGTON HWY | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086973300 | ||||||||
| FaxNumber: | 8086973687 | ||||||||
| Practice Location | |||||||||
| Address1: | 85-251 FARRINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967922113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086973520 | ||||||||
| FaxNumber: | 8086973521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2018 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | Z | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8086973300 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.