Healthcare Provider Details

I. General information

NPI: 1588136816
Provider Name (Legal Business Name): PACIFIC HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S KING ST STE 604
HONOLULU HI
96814-1707
US

IV. Provider business mailing address

1010 S KING ST STE 604
HONOLULU HI
96814-1707
US

V. Phone/Fax

Practice location:
  • Phone: 808-852-8535
  • Fax: 808-376-8346
Mailing address:
  • Phone: 808-852-8535
  • Fax: 808-376-8346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY W. SAKAGUCHI
Title or Position: OWNER
Credential: MD
Phone: 808-341-9424