Healthcare Provider Details

I. General information

NPI: 1144433053
Provider Name (Legal Business Name): PACIFIC CANCER INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

100 BAYVIEW CIR STE 400
NEWPORT BEACH CA
92660-2984
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-2600
  • Fax: 808-242-2626
Mailing address:
  • Phone: 949-242-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JOHNS
Title or Position: EVP, GENERAL COUNSEL-SEC.
Credential:
Phone: 800-544-3215