Provider Demographics
NPI:1932583978
Name:RONG RONG ENTERPRISE L.L.C.
Entity Type:Organization
Organization Name:RONG RONG ENTERPRISE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-783-2468
Mailing Address - Street 1:92-1001 ALIINUI DR
Mailing Address - Street 2:28C
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2250
Mailing Address - Country:US
Mailing Address - Phone:808-783-2468
Mailing Address - Fax:
Practice Address - Street 1:377 KEAHOLE STREET
Practice Address - Street 2:E211-D
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-0868
Practice Address - Country:US
Practice Address - Phone:808-783-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1235243981OtherNPI-INDIVIDUAL