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General NPI Number Information
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NPI Number | 1396789665
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Entity Type | Organization
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Legal Business Name | GLAUCOMA CENTER OF HAWAII, LLC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 1441 KAPIOLANI BLVD SUITE 1403
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City | HONOLULU
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State | HI
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Zip | 96814-4401
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Country | US
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Telephone | 808-945-2222
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Fax | 808-945-2220
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Provider Business Mailing Address
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Address Line | 1441 KAPIOLANI BLVD SUITE 1403
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City | HONOLULU
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State | HI
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Zip | 96814-4401
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Country | US
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Telephone | 808-945-2222
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Fax | 808-945-2220
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARSHALL KIM
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Credential | M.D., PH.D.
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Telephone | 808-945-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 13515
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License Number State | HI
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