Healthcare Provider Details

I. General information

NPI: 1417191784
Provider Name (Legal Business Name): HAWAII PAIN SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA STREET SUITE 102
HONOLULU HI
96813-2461
US

IV. Provider business mailing address

350 WARD AVENUE, SUITE 106, #367
HONOLULU HI
96814-4004
US

V. Phone/Fax

Practice location:
  • Phone: 808-445-9120
  • Fax: 808-445-9124
Mailing address:
  • Phone: 808-445-9120
  • Fax: 808-445-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberDOS-1366
License Number StateHI

VIII. Authorized Official

Name: DR. PHILLIP LIM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 808-445-9120