Healthcare Provider Details

I. General information

NPI: 1962953372
Provider Name (Legal Business Name): HAWAII PAIN SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST SUITE 102
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1329 LUSITANA ST SUITE 102
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-445-9120
  • Fax: 808-445-9124
Mailing address:
  • Phone: 808-445-9120
  • Fax: 808-445-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDOS1366
License Number StateHI

VIII. Authorized Official

Name: PHILLIP LIM
Title or Position: CEO
Credential: DO
Phone: 714-676-5541