Provider Demographics
NPI:1912195322
Name:RUESING, HEAJUNG (MD)
Entity Type:Individual
Prefix:
First Name:HEAJUNG
Middle Name:
Last Name:RUESING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 ULULANI ST
Mailing Address - Street 2:#108
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3913
Mailing Address - Country:US
Mailing Address - Phone:808-935-2389
Mailing Address - Fax:808-934-4816
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:#108
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-935-2389
Practice Address - Fax:808-934-4816
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7563207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07075101Medicaid
HIA0091981OtherHMSA
HI07075101Medicaid
HIH0000BFCZCMedicare PIN