Healthcare Provider Details

I. General information

NPI: 1376889295
Provider Name (Legal Business Name): HAWAII RADIATION ONCOLOGY CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST
HONOLULU HI
96817-2336
US

IV. Provider business mailing address

347 N KUAKINI ST
HONOLULU HI
96817-2336
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-9548
  • Fax:
Mailing address:
  • Phone: 808-547-9548
  • Fax: 808-547-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD11138
License Number StateHI

VIII. Authorized Official

Name: DR. WINLOVE BONPUA SUASIN
Title or Position: OWNER
Credential: MD
Phone: 671-488-6893