=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386813095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CCK DANIEL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2008
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 ENA ROAD #603
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-732-0888
-----------------------------------------------------
Fax | 808-737-6648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4224 WAIALAE AVE #525
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-732-0888
-----------------------------------------------------
Fax | 808-737-6648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | COLL K DANIEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-732-0888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------