Provider Demographics
NPI:1730184300
Name:HESLINGA, DAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:HESLINGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 LILOA RISE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1953
Mailing Address - Country:US
Mailing Address - Phone:808-729-1796
Mailing Address - Fax:555-555-5555
Practice Address - Street 1:2386 LILOA RISE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822
Practice Address - Country:US
Practice Address - Phone:808-729-1796
Practice Address - Fax:808-800-2318
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02470501Medicaid
HIA02772Medicare UPIN
HIH54031Medicare ID - Type Unspecified