Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 952 | HI |
NPI | 1003027319 |
---|---|
Provider Name | Ms. Chong Son An |
First Address | Mililani, HI 96789-1402 |
Second Address | Honolulu, HI 96819-1469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 17/03/2021 |