Provider Demographics
NPI:1871916767
Name:ISLAND WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:ISLAND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:YOSHIO
Authorized Official - Last Name:UCHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:808-589-1955
Mailing Address - Street 1:615 PIIKOI STREET
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-589-1955
Mailing Address - Fax:808-589-1712
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-589-1955
Practice Address - Fax:808-589-1712
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISLAND WELLNESS CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIND-0082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty