NPI 1457446585

Pediatric Medical Group, LLC

Organisation Preferred Provider Organization Honolulu, HI

Practice location

Address: 1712 Liliha Street Suite304, Honolulu, HI 96817-3114
Phone: (808) 522-1313
Fax: (808) 522-1309

Authorised official

Name: Amelia Reyes Jacang
Title: Pediatrician
Phone: (808) 522-1313

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 1854 (HI)

Other Preferred Provider Organization providers in Hawaii →

Registry record

NPI: 1457446585
Entity type: Organization
NPI issued: 4 Oct 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.