1720267941 NPI number — CARDIOVASCULAR CARE HAWAII, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720267941 NPI number — CARDIOVASCULAR CARE HAWAII, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR CARE HAWAII, 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:
Provider Other Organization Name Type Code:
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:
1720267941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3908 WAOKANAKA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-291-3932
Provider Business Mailing Address Fax Number:
808-595-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1029 KAPAHULU AVE
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-218-7836
Provider Business Practice Location Address Fax Number:
808-218-7882
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DACANAY
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
808-291-3932

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD6033 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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