Healthcare Provider Details

I. General information

NPI: 1790921815
Provider Name (Legal Business Name): SUASIN CANCER CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST NAEA TOWER, RADIATION ONCOLOGY DEPT.
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

PO BOX 1300 MAIL CODE 61105
HONOLULU HI
96807-1300
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-4771
  • Fax: 808-547-4570
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number223807-D1
License Number StateHI

VIII. Authorized Official

Name: DR. WINLOVE B. SUASIN
Title or Position: OWNER
Credential: MD
Phone: 808-537-7143