Provider Demographics
NPI:1215004627
Name:DENNY BALES MD FACC INC
Entity Type:Organization
Organization Name:DENNY BALES MD FACC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-521-7402
Mailing Address - Street 1:1585 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4522
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:808-941-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI015828Medicaid
HI015828Medicaid