Sue Bourgeoishunt, LMT
Individual provider Active NPI Specialist · Wailuku, HI
NPI 1992912257 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992912257
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- LMT4374 (HI)
- Practice address
- 35 Lunalilo Street
Unit 102
Wailuku, HI 96793 - Phone
- (808) 244-6363
- Fax
- (808) 249-2151
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMT4374 | HI | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jocelyn U Chang DO Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | LMT4374 | HI | Yes |
Addresses
Primary practice location
35 Lunalilo Street
Unit 102
Wailuku, HI 96793
Mailing address
35 Lunalilo St
Unit 102
Wailuku, HI 96793
Phone (808) 244-6363
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LMT4374 | Other | HI | LICENSE |
Other providers in Wailuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.