Provider Demographics
NPI:1245289933
Name:HEAJUNG RUESING MD INC
Entity type:Organization
Organization Name:HEAJUNG RUESING MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEAJUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:RUESING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-935-2389
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:808-935-5109
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:808-935-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7563208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0091981OtherHMSA
HI743824Medicaid
HI743824Medicaid
H0000BFCZCMedicare PIN