Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DT-944 | HI |
NPI | 1053461434 |
---|---|
Provider Name | Dr. Alan Tom |
First Address | Honolulu, HI 96813-4920 |
Second Address | Kahului, HI 96732-1610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |