1417191784 NPI number — HAWAII PAIN SPECIALISTS, LLC

Table of content: (NPI 1417191784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417191784 NPI number — HAWAII PAIN SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII PAIN SPECIALISTS, 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:
1417191784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 WARD AVENUE, SUITE 106, #367
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:
96814-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-445-9120
Provider Business Mailing Address Fax Number:
808-445-9124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 LUSITANA STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-445-9120
Provider Business Practice Location Address Fax Number:
808-445-9124
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-445-9120

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  DOS-1366 , 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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