Provider Demographics
NPI:1093894412
Name:HAWAII FOOT CLINIC, LLC
Entity Type:Organization
Organization Name:HAWAII FOOT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-536-6584
Mailing Address - Street 1:50 S BERETANIA ST
Mailing Address - Street 2:SUITE C-111
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2208
Mailing Address - Country:US
Mailing Address - Phone:808-536-6584
Mailing Address - Fax:
Practice Address - Street 1:50 S BERETANIA ST
Practice Address - Street 2:SUITE C-111
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2208
Practice Address - Country:US
Practice Address - Phone:808-536-6584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100468Medicare UPIN