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General NPI Number Information
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NPI Number | 1043502792
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Entity Type | Organization
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Legal Business Name | PACIFIC ASC LLC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 650 IWILEI RD SPACE #225
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City | HONOLULU
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State | HI
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Zip | 96817-5086
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Country | US
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Telephone | 808-949-2208
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Fax | 808-949-2209
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Provider Business Mailing Address
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Address Line | 1946 YOUNG ST SUITE 288
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City | HONOLULU
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State | HI
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Zip | 96826-2169
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Country | US
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Telephone | 808-949-2208
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Fax | 808-949-2209
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Authorized Official
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Title or Position | MEMBER
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Name | MR. DOUGLAS M TONOKAWA
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Credential |
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Telephone | 808-949-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | PENDING
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License Number State | HI
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