Provider Demographics
NPI:1669584967
Name:CHONG, BLANE KALANI (M D)
Entity type:Individual
Prefix:DR
First Name:BLANE
Middle Name:KALANI
Last Name:CHONG
Suffix:
Gender:M
Credentials:M D
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Mailing Address - Street 1:3221 WAIALAE AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5842
Mailing Address - Country:US
Mailing Address - Phone:808-732-9710
Mailing Address - Fax:808-732-9720
Practice Address - Street 1:3221 WAIALAE AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5842
Practice Address - Country:US
Practice Address - Phone:808-732-9710
Practice Address - Fax:808-732-9720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI9183207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF88077Medicare UPIN