=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033457452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGLINAO MEDICAL MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2013
-----------------------------------------------------
Last Update Date | 01/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 347 N KUAKINI ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-536-2236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1324 UILA ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96818-1937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-392-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | THOMAS MAGLINAO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-392-1988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 16756
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------