1134317571 NPI number — WAIMEA PACIFIC ENTERPRISES, LLC

Table of content: DONNA MARIE BENNETT (NPI 1821577404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134317571 NPI number — WAIMEA PACIFIC ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAIMEA PACIFIC ENTERPRISES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LYN LAM, M.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134317571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAMUELA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96743-7109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-885-7511
Provider Business Mailing Address Fax Number:
808-885-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65-1267 KAWAIHAE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-885-7511
Provider Business Practice Location Address Fax Number:
808-885-0933
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
LYN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-885-7511

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com