Basic Information
| Provider Information | |||||||||
| NPI: | 1902491707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AWAI | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | KEAUPUNI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5719 ERNE AVE | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967063233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539482920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 98-211 PALI MOMI ST STE 830 | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085231600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2021 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | AMD-1033 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.