Provider Demographics
NPI:1801162797
Name:THIELEN, ZACHARY
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:THIELEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WELLS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2365
Mailing Address - Country:US
Mailing Address - Phone:808-649-1487
Mailing Address - Fax:808-437-2512
Practice Address - Street 1:1830 WELLS ST STE 103
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2365
Practice Address - Country:US
Practice Address - Phone:808-649-1487
Practice Address - Fax:808-437-2512
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19536207XS0114X
CAA129535207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery