Healthcare Provider Details

I. General information

NPI: 1548299811
Provider Name (Legal Business Name): OAHU IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2141 FORT WEAVER RD
EWA BEACH HI
96706-1993
US

IV. Provider business mailing address

PO BOX 971135
WAIPAHU HI
96797-8135
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-3000
  • Fax:
Mailing address:
  • Phone: 808-447-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD-7517
License Number StateHI

VIII. Authorized Official

Name: DR. SHAY J LEE
Title or Position: OWNER
Credential: M.D.
Phone: 808-447-9218