Healthcare Provider Details

I. General information

NPI: 1841318128
Provider Name (Legal Business Name): PACIFIC COAST MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 YOUNG ST
HONOLULU HI
96814-1916
US

IV. Provider business mailing address

1229 YOUNG ST
HONOLULU HI
96814-1916
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-7702
  • Fax: 808-591-7704
Mailing address:
  • Phone: 808-591-7702
  • Fax: 808-591-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD-11181
License Number StateHI

VIII. Authorized Official

Name: DR. LENHANH P TRAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 808-591-7702