Provider Demographics
NPI:1437894524
Name:HILO OSTEOPATHIC FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:HILO OSTEOPATHIC FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-961-6922
Mailing Address - Street 1:780 LAUKAPU ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4433
Mailing Address - Country:US
Mailing Address - Phone:808-961-6922
Mailing Address - Fax:808-935-6640
Practice Address - Street 1:780 LAUKAPU ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4433
Practice Address - Country:US
Practice Address - Phone:808-961-6922
Practice Address - Fax:808-935-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1649599473Medicaid