Organization
PEDIATRIC MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMELIA REYES JACANG M.D. (PEDIATRICIAN)
(808) 522-1313
Entity
Organization
Contact information
Practice address
1712 LILIHA STREET, SUITE304, HONOLULU, HI 96817-3114
(808) 522-1313
(808) 522-1309
Mailing address
1712 LILIHA STREET, SUITE304, HONOLULU, HI 96817-3114
(808) 522-1313
(808) 522-1309
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
1854
HI
Other
Enumeration date
10/04/2006
Last updated
08/22/2020
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