Outreach Medical Group Downtown LLC
Organization Active NPI Nurse Practitioner · Honolulu, HI
NPI 1659080901 · NPPES record last updated Aug 2, 2023
Key facts
- NPI
- 1659080901
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- OUTREACH MEDICAL GROUP DOWNTOWN LLC
- Practice address
- 928 Nuuanu Ave # 1-C
Honolulu, HI 96817-5190 - Phone
- (808) 845-5550
- Fax
- (808) 845-5557
- NPI assigned
- Nov 15, 2022
- Organization subpart
- No
Authorized official
- Name
- Mr. Derek M Tengan, PHARM.D.
- Title
- Member
- Phone
- (808) 845-5550
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 12D2274449 | Outreach Medical Group Downtown, LLC | Certificate of waiver | Jan 3, 2027 |
National Provider Directory
Locations
928 Nuuanu Ave
#1C
Honolulu, HI 96817
Phone (808) 845-5550
94-449 Akoki St
Ste 104
Waipahu, HI 96797
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
928 Nuuanu Ave # 1-C
Honolulu, HI 96817-5190
Mailing address
94-449 Akoki St Ste 104
Waipahu, HI 96797-2732
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.