Provider Demographics
NPI:1467562363
Name:LUM, DANIELLE TUCK WAI (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:TUCK WAI
Last Name:LUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:56-119 PUALALEA ST
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2052
Mailing Address - Country:US
Mailing Address - Phone:808-293-9216
Mailing Address - Fax:808-293-1511
Practice Address - Street 1:56-119 PUALALEA ST
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2052
Practice Address - Country:US
Practice Address - Phone:808-293-9216
Practice Address - Fax:808-293-1511
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064882208000000X
HI17397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics