Provider Demographics
NPI:1689927758
Name:DEPT. OF HEALTH-HAWAII-DEVELOPMENTAL DISABILITIES DIVISION CMU5
Entity type:Organization
Organization Name:DEPT. OF HEALTH-HAWAII-DEVELOPMENTAL DISABILITIES DIVISION CMU5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-586-5842
Mailing Address - Street 1:1250 PUNCHBOWL ST
Mailing Address - Street 2:ROOM 463 ATTN: PHAO
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 WAIMANO HOME RD
Practice Address - Street 2:HALE 'E'
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1474
Practice Address - Country:US
Practice Address - Phone:808-587-6043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities