Provider Demographics
NPI:1891231940
Name:PANGILINAN, PAUL-JOHN (RDN)
Entity Type:Individual
Prefix:MR
First Name:PAUL-JOHN
Middle Name:
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 ALA LILIKOI ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2430
Mailing Address - Country:US
Mailing Address - Phone:808-778-4386
Mailing Address - Fax:
Practice Address - Street 1:837 ALA LILIKOI ST APT 2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-2430
Practice Address - Country:US
Practice Address - Phone:808-778-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI86049021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered