Healthcare Provider Details

I. General information

NPI: 1396560686
Provider Name (Legal Business Name): PALLIATIVE CARE HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KAPIOLANI BLVD STE 500
HONOLULU HI
96813-5258
US

IV. Provider business mailing address

770 KAPIOLANI BLVD STE 500
HONOLULU HI
96813-5258
US

V. Phone/Fax

Practice location:
  • Phone: 808-931-0717
  • Fax:
Mailing address:
  • Phone: 808-931-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SU
Title or Position: CEO
Credential:
Phone: 808-931-0717