Provider Demographics
NPI:1235574419
Name:MAUNA KEA HEALING CENTER,LLC
Entity Type:Organization
Organization Name:MAUNA KEA HEALING CENTER,LLC
Other - Org Name:MARY JANG FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:INKYEONG
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-386-7230
Mailing Address - Street 1:1451 S KING ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2506
Mailing Address - Country:US
Mailing Address - Phone:808-941-7799
Mailing Address - Fax:
Practice Address - Street 1:1451 S KING ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2506
Practice Address - Country:US
Practice Address - Phone:808-941-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1044171100000X
HI1042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty