1467884536 NPI number — ALOHA DERMATOLOGY AND LASER CENTER 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 1467884536 NPI number — ALOHA DERMATOLOGY AND LASER CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALOHA DERMATOLOGY AND LASER CENTER 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:
6
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:
1467884536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUUNENE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96784-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-877-6526
Provider Business Mailing Address Fax Number:
808-877-7033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 HOOKELE ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-877-6526
Provider Business Practice Location Address Fax Number:
808-877-7033
Provider Enumeration Date:
07/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LY
Authorized Official First Name:
MICKI
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
808-877-6526

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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