Healthcare Provider Details

I. General information

NPI: 1487914347
Provider Name (Legal Business Name): MALAMA IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST SUITE 310
HONOLULU HI
96814-1870
US

IV. Provider business mailing address

1401 S BERETANIA ST SUITE 310
HONOLULU HI
96814-1870
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-4055
  • Fax:
Mailing address:
  • Phone: 808-524-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number15081
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6492
License Number StateHI

VIII. Authorized Official

Name: DR. RAYDEEN M FUJIMOTO-BUSSE
Title or Position: OWNER
Credential: MD
Phone: 808-524-4055