=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265769301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAJ MEDICAL EQUIPMENT AND SUPPLIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2009
-----------------------------------------------------
Last Update Date | 11/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 MCCULLY ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-343-5522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 MCCULLY ST 732 HAOULI STREET
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-343-5522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DENISSE DJ JOSON
-----------------------------------------------------
Credential | M.A., C.N.A
-----------------------------------------------------
Telephone | 808-343-5522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | W0547257601
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------