Provider Demographics
NPI:1194568212
Name:MALAMA DERMATOLOGY, LLC
Entity type:Organization
Organization Name:MALAMA DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIM ON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-940-0961
Mailing Address - Street 1:3221 WAIALAE AVE STE 382
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5845
Mailing Address - Country:US
Mailing Address - Phone:808-940-0961
Mailing Address - Fax:808-201-4951
Practice Address - Street 1:3221 WAIALAE AVE STE 382
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5845
Practice Address - Country:US
Practice Address - Phone:808-940-0961
Practice Address - Fax:808-201-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty