Healthcare Provider Details

I. General information

NPI: 1497320402
Provider Name (Legal Business Name): OAHU PAIN CARE HILO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PAUAHI ST STE 101
HILO HI
96720-3043
US

IV. Provider business mailing address

1122 MAIHA CIR
PEARL CITY HI
96782-1462
US

V. Phone/Fax

Practice location:
  • Phone: 808-933-7222
  • Fax: 808-933-7224
Mailing address:
  • Phone: 808-783-7613
  • Fax: 808-531-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUIS PAU
Title or Position: PRESIDENT
Credential: MD
Phone: 808-933-7222