Provider Demographics
NPI:1861473233
Name:GAMBOA, BENJAMIN TIONGSON (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TIONGSON
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S WAKEA AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1385
Mailing Address - Country:US
Mailing Address - Phone:808-873-0299
Mailing Address - Fax:808-873-0290
Practice Address - Street 1:135 S WAKEA AVE
Practice Address - Street 2:STE 107
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1385
Practice Address - Country:US
Practice Address - Phone:808-873-0299
Practice Address - Fax:808-873-0290
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHD8771207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000201368OtherHMSA QUEST
201368OtherHMSA
HIA07457901OtherALOHACARE
HI07457901Medicaid
B01399Medicare UPIN
201368OtherHMSA