Provider Demographics
NPI:1023016383
Name:BALES, DENNY L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNY
Middle Name:L
Last Name:BALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-521-7402
Mailing Address - Fax:808-537-2094
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-521-7402
Practice Address - Fax:808-537-2094
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
HIMD4933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01582801Medicaid
HIMD4933-02OtherMDX-QUEEN'S HEALTHCARE
HIC017008OtherHMSA
HIH53585Medicare ID - Type Unspecified
HIC97326Medicare UPIN