Provider Demographics
NPI:1841601937
Name:LUM, NICOLE MAHEALANI (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE MAHEALANI
Middle Name:
Last Name:LUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N KUAKINI ST STE 308
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2360
Mailing Address - Country:US
Mailing Address - Phone:808-440-6852
Mailing Address - Fax:808-440-6878
Practice Address - Street 1:321 N KUAKINI ST STE 308
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2360
Practice Address - Country:US
Practice Address - Phone:808-440-6852
Practice Address - Fax:808-440-6878
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1825207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI990288045OtherNON-PROFIT
HI826175Medicaid