Provider Demographics
NPI:1740357920
Name:WELHAM, JENNY HORITA (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:HORITA
Last Name:WELHAM
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 1:1401 S BERETANIA ST STE 370
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1871
Mailing Address - Country:US
Mailing Address - Phone:808-944-1844
Mailing Address - Fax:808-947-9987
Practice Address - Street 1:1401 S BERETANIA ST STE 370
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1871
Practice Address - Country:US
Practice Address - Phone:808-944-1844
Practice Address - Fax:808-947-9987
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-17885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI797277Medicaid