Provider Demographics
NPI:1184804981
Name:LI, MICHAEL CARLUN (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CARLUN
Last Name:LI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2022
Mailing Address - Country:US
Mailing Address - Phone:808-676-5000
Mailing Address - Fax:808-674-1640
Practice Address - Street 1:890 KAMOKILA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2022
Practice Address - Country:US
Practice Address - Phone:808-676-5000
Practice Address - Fax:808-674-1640
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD 310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant