Provider Demographics
NPI:1285729640
Name:IRELAND, JULIE WON (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:WON
Last Name:IRELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:B
Other - Last Name:WON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-2139 FORT WEAVER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3607
Mailing Address - Country:US
Mailing Address - Phone:808-676-4224
Mailing Address - Fax:
Practice Address - Street 1:91-2139 FORT WEAVER RD STE 100
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3608
Practice Address - Country:US
Practice Address - Phone:808-676-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11842207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57646501Medicaid
HI0000257543OtherHMSA BILLING NUMBER
HI57646501Medicaid
HIH101270Medicare PIN