Provider Demographics
NPI:1003257585
Name:HAWAII COLLEGE OF ORIENTAL MEDICINE
Entity type:Organization
Organization Name:HAWAII COLLEGE OF ORIENTAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / DEAN
Authorized Official - Prefix:PROF
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:PETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, EAMP, LAC,
Authorized Official - Phone:808-981-2790
Mailing Address - Street 1:93 BANYAN DR STE 10
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:93 BANYAN DR STE 10
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4632
Practice Address - Country:US
Practice Address - Phone:808-933-1369
Practice Address - Fax:866-757-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1054171100000X
HIACU-1056171100000X
HIACU-1070171100000X
HI671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty