Provider Demographics
NPI:1386820405
Name:JING PING REHABILITATION CLINIC LLC
Entity type:Organization
Organization Name:JING PING REHABILITATION CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JINGPING
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-949-3274
Mailing Address - Street 1:1820 KAIOO DR.
Mailing Address - Street 2:A309
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-5818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 KAIOO DR.
Practice Address - Street 2:A309
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-5818
Practice Address - Country:US
Practice Address - Phone:808-949-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-10190320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities