Provider Demographics
NPI:1811120082
Name:EDWARD L. CHESNE, M.D., INC.
Entity type:Organization
Organization Name:EDWARD L. CHESNE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:CHESNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-521-7402
Mailing Address - Street 1:1380 LUSITANA STREET
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2461
Mailing Address - Country:US
Mailing Address - Phone:808-521-7402
Mailing Address - Fax:808-537-2094
Practice Address - Street 1:1380 LUSITANA STREET
Practice Address - Street 2:SUITE 1002
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2461
Practice Address - Country:US
Practice Address - Phone:808-521-7402
Practice Address - Fax:808-537-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD1304207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01905101Medicaid
HI20503OtherHMSA (B/C B/S OF HAWAII)
HI0000BBFJGMedicare PIN
HIE46476Medicare UPIN