Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD-5585 | HI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD-5585 | HI |
NPI | 1174624019 |
---|---|
Provider Name | Dr. Alan S. W. Song |
First Address | Wailuku, HI 96793-2531 |
Second Address | Kihei, HI 96753-6945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A0024073 | HMSA BILLING NUMBER (01) | HI |
021746-02 | (05) | HI |
D43499 | (02) | HI |