Provider Demographics
NPI:1093911463
Name:MANOA FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:MANOA FAMILY MEDICINE, LLC
Other - Org Name:MANOA FAMILY MEDICINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:KYU-HONG
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-988-8700
Mailing Address - Street 1:2756 WOODLAWN DR
Mailing Address - Street 2:SUITE 6-202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1856
Mailing Address - Country:US
Mailing Address - Phone:808-988-8700
Mailing Address - Fax:808-988-1806
Practice Address - Street 1:2756 WOODLAWN DR
Practice Address - Street 2:SUITE 6-202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1856
Practice Address - Country:US
Practice Address - Phone:808-988-8700
Practice Address - Fax:808-988-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13732207Q00000X
HI13989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty