Healthcare Provider Details
I. General information
NPI: 1679505085
Provider Name (Legal Business Name): HAWAII VASCULAR AND ENDOVASCULAR INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/07/2006
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
550 S BERETANIA ST STE 505
HONOLULU HI
96813-2496
US
IV. Provider business mailing address
PO BOX 25370
HONOLULU HI
96825-0370
US
V. Phone/Fax
- Phone: 808-440-0544
- Fax:
- Phone: 808-536-0314
- Fax: 808-536-0320
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2086S0129X |
| Taxonomy | Vascular Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
DEAN
SATO
Title or Position: OWNER
Credential: M.D.
Phone: 808-440-0544