Healthcare Provider Details

I. General information

NPI: 1073272738
Provider Name (Legal Business Name): AETHER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST
HONOLULU HI
96813-2414
US

IV. Provider business mailing address

4028A KEANU ST
HONOLULU HI
96816-4242
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROY ESAKI
Title or Position: PRESIDENT
Credential:
Phone: 617-852-2511