Healthcare Provider Details

I. General information

NPI: 1417061060
Provider Name (Legal Business Name): HAWAII BREAST CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 S BERETANIA ST SUITE 501
HONOLULU HI
96826-1301
US

IV. Provider business mailing address

1907 S BERETANIA ST SUITE 501
HONOLULU HI
96826-1301
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-3444
  • Fax: 808-949-7808
Mailing address:
  • Phone: 808-949-3444
  • Fax: 808-949-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LAURA WELDON HOQUE
Title or Position: MEMBER
Credential: M.D.
Phone: 808-949-3444