Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD10106 | HI |
NPI | 1245655794 |
---|---|
Provider Name | Dr. Marni Lum Dezzani |
First Address | Honolulu, HI 96819-3227 |
Second Address | Honolulu, HI 96815-4488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2014 |
Last Update Date | 20/02/2014 |