Healthcare Provider Details

I. General information

NPI: 1811161565
Provider Name (Legal Business Name): PACIFIC PLASTIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46-001 KAMEHAMEHA HWY SUITE 412
KANEOHE HI
96744-3711
US

IV. Provider business mailing address

46-001 KAMEHAMEHA HWY SUITE 412
KANEOHE HI
96744-3711
US

V. Phone/Fax

Practice location:
  • Phone: 808-735-7681
  • Fax: 808-734-0027
Mailing address:
  • Phone: 808-735-7681
  • Fax: 808-734-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number5620
License Number StateHI

VIII. Authorized Official

Name: ALLEN STRASBERGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-735-7681