Healthcare Provider Details

I. General information

NPI: 1629183801
Provider Name (Legal Business Name): MID PACIFIC ENT INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST #902
HONOLULU HI
96817-6302
US

IV. Provider business mailing address

405 N KUAKINI ST #902
HONOLULU HI
96817-6302
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-0400
  • Fax: 808-533-0401
Mailing address:
  • Phone: 808-533-0400
  • Fax: 808-533-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberD05912
License Number StateHI

VIII. Authorized Official

Name: TIMOTHY J MCLAUGHLIN
Title or Position: OWNER PHYSICIAN
Credential: DO
Phone: 808-533-0400