Provider Demographics
NPI:1770751729
Name:LANG, LISSA
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:
Other - Last Name:HOOKAULIKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3727 WAHA RD
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-9609
Mailing Address - Country:US
Mailing Address - Phone:808-639-9888
Mailing Address - Fax:808-332-5518
Practice Address - Street 1:3727 WAHA RD
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-9609
Practice Address - Country:US
Practice Address - Phone:808-639-9888
Practice Address - Fax:808-332-5518
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW0039951601332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51709701Medicaid
HI236778OtherHMSA
HI51709701OtherALOHA CARE
HI4544720001Medicare NSC