# WAILEA MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497769988
- **Authorized official:** MR. GREGORY L PARK MD (M.D.)
- **Authorized official phone:** (808) 875-9095

## Contact information

- **Practice address:** 161 WAILEA IKE PL, \#B102, WAILEA, HI 96753-6521
- **Practice address phone:** (808) 875-9095
- **Practice address fax:** (808) 875-9098
- **Mailing address:** 161 WAILEA IKE PL, B-102, WAILEA, HI 96753-6521
- **Mailing address phone:** (808) 875-9095
- **Mailing address fax:** (808) 875-9098

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 3915 | HI | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 09/16/2015