Provider Demographics
NPI:1891208930
Name:PONO PODIATRY, LLC
Entity Type:Organization
Organization Name:PONO PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WING
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-727-2117
Mailing Address - Street 1:40 KUPUOHI ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-2714
Mailing Address - Country:US
Mailing Address - Phone:808-727-2117
Mailing Address - Fax:808-793-2238
Practice Address - Street 1:40 KUPUOHI ST STE 204
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2714
Practice Address - Country:US
Practice Address - Phone:808-727-2117
Practice Address - Fax:808-793-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-12
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-202213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty