Healthcare Provider Details

I. General information

NPI: 1932366606
Provider Name (Legal Business Name): JJTM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

102 KIIONIONI PL
HONOLULU HI
96816-4248
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-4771
  • Fax: 808-545-8577
Mailing address:
  • Phone: 808-295-5566
  • Fax: 808-955-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number7901
License Number StateHI

VIII. Authorized Official

Name: DR. SCOTT D. M. MOON
Title or Position: MEMBER/MANAGER
Credential: M.D.
Phone: 808-295-5566