Provider Demographics
NPI:1871531335
Name:HONOLULU ORTHOPEDIC SUPPLY, INC.
Entity type:Organization
Organization Name:HONOLULU ORTHOPEDIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:MK
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:808-847-0099
Mailing Address - Street 1:935 DILLINGHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4539
Mailing Address - Country:US
Mailing Address - Phone:808-847-0099
Mailing Address - Fax:808-847-1051
Practice Address - Street 1:935 DILLINGHAM BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4539
Practice Address - Country:US
Practice Address - Phone:808-847-0099
Practice Address - Fax:808-847-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIABC #090831335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04999401Medicaid
HIA5698-4OtherHI MEDICAL SERVICE ASSN.
HI04999401Medicaid