Healthcare Provider Details

I. General information

NPI: 1952508921
Provider Name (Legal Business Name): PALI MOMI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD
AIEA HI
96701-4713
US

IV. Provider business mailing address

1946 YOUNG ST SUITE 320
HONOLULU HI
96826-2169
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-6000
  • Fax:
Mailing address:
  • Phone: 808-973-7320
  • Fax: 808-973-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID OKABE
Title or Position: CFO, SR. VICE PRESIDENT
Credential:
Phone: 808-535-7202