Provider Demographics
NPI:1558769430
Name:VALLY MEDICAL GROUP, APC
Entity Type:Organization
Organization Name:VALLY MEDICAL GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLY-MAHOMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-333-3544
Mailing Address - Street 1:475 KINOOLE ST
Mailing Address - Street 2:SUITE 102-150
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2900
Mailing Address - Country:US
Mailing Address - Phone:808-333-3544
Mailing Address - Fax:808-333-3545
Practice Address - Street 1:345 KAUILA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2107
Practice Address - Country:US
Practice Address - Phone:808-333-3544
Practice Address - Fax:808-333-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD15396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty