Provider Demographics
NPI:1629148226
Name:IVF HAWAII, LLC
Entity Type:Organization
Organization Name:IVF HAWAII, LLC
Other - Org Name:IVF HAWAII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENTON
Authorized Official - Middle Name:HH
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-538-6655
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-538-6655
Mailing Address - Fax:808-537-5500
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 607
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-538-6655
Practice Address - Fax:808-537-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3781207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000228874OtherHMSA PROVIDER #
HI0000228874OtherFED EMP PLAN PROV #
HI0000228874OtherBLUE CARD HAWAII PROV #
HIMD3781-02OtherMDX HAWAII
HI15184449OtherUHA PROVIDER #