Individual
CHANTHAVILAY PHANTHANOUVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1314 S KING ST, HONOLULU, HI 96814-1956
(808) 541-7209
Mailing address
47-505 ALAWIKI ST, KANEOHE, HI 96744-4684
(808) 541-7209
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/27/2012
Last updated
02/27/2012
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