Basic Information
Provider Information
NPI: 1003009804
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOLK
FirstName: JILL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 407 ULUNIU ST STE 411
Address2:  
City: KAILUA
State: HI
PostalCode: 967342544
CountryCode: US
TelephoneNumber: 8082637203
FaxNumber: 8082634604
Practice Location
Address1: 407 ULUNIU ST STE 411
Address2:  
City: KAILUA
State: HI
PostalCode: 967342544
CountryCode: US
TelephoneNumber: 8082637203
FaxNumber: 8082634604
Other Information
ProviderEnumerationDate: 08/24/2007
LastUpdateDate: 03/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X1405SCY Allopathic & Osteopathic PhysiciansEmergency Medicine 
390200000XUO1748FLN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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