Provider Demographics
NPI:1417580275
Name:THE QUEENS MEDICAL CENTER
Entity Type:Organization
Organization Name:THE QUEENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ EXEC VP
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-691-7989
Mailing Address - Street 1:449 KAPAHULU AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3850
Mailing Address - Country:US
Mailing Address - Phone:808-735-0007
Mailing Address - Fax:808-735-0021
Practice Address - Street 1:91-6390 KAPOLEI PKWY
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-735-0007
Practice Address - Fax:808-735-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care