Provider Demographics
NPI:1588309173
Name:APEX PROVIDER SOLUTIONS, LLC
Entity type:Organization
Organization Name:APEX PROVIDER SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TENGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:808-600-3368
Mailing Address - Street 1:94-449 AKOKI ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2732
Mailing Address - Country:US
Mailing Address - Phone:808-660-3368
Mailing Address - Fax:
Practice Address - Street 1:928 NUUANU AVE # 1-B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5190
Practice Address - Country:US
Practice Address - Phone:808-600-3368
Practice Address - Fax:808-842-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center