Provider Demographics
NPI:1154638849
Name:CHRISTIAN W. BOYENS, M.D. INC.
Entity Type:Organization
Organization Name:CHRISTIAN W. BOYENS, M.D. INC.
Other - Org Name:CHRISTIAN W. BOYENS, M.D. LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLO PHYSICIAN CORPORATION/-FAMILY
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOYENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-263-1330
Mailing Address - Street 1:40 AULIKE STREET
Mailing Address - Street 2:SUITE # 217
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2753
Mailing Address - Country:US
Mailing Address - Phone:808-263-1330
Mailing Address - Fax:808-263-1335
Practice Address - Street 1:40 AULIKE STREET
Practice Address - Street 2:SUITE # 217
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2753
Practice Address - Country:US
Practice Address - Phone:808-263-1330
Practice Address - Fax:808-263-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00I0203886OtherHMSA (BC/BS)
HI07636101Medicaid
HI00H0203888OtherHMSA (BC/BS)
HI00H0203888OtherHMSA (BC/BS)
H54755Medicare PIN