Provider Demographics
NPI:1114036811
Name:RONALD Y S CHOCK MD INC
Entity Type:Organization
Organization Name:RONALD Y S CHOCK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-537-2895
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:#512
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-537-2895
Mailing Address - Fax:808-537-2010
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:#512
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-537-2895
Practice Address - Fax:808-537-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5074207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01900702Medicaid
HI2039-6OtherHMSA BLUE CROSS INS NUMBE
HI01900702Medicaid
HIC99007Medicare UPIN