Healthcare Provider Details

I. General information

NPI: 1689774499
Provider Name (Legal Business Name): DAGU PROFESSIONAL SERVICES LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

PO BOX 10813
HONOLULU HI
96816-0813
US

V. Phone/Fax

Practice location:
  • Phone: 877-445-4406
  • Fax:
Mailing address:
  • Phone: 877-445-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-4869
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD-4869
License Number StateHI

VIII. Authorized Official

Name: GARY M. CABOT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 877-445-4406