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General NPI Number Information
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NPI Number | 1487914347
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Entity Type | Organization
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Legal Business Name | MALAMA IMAGING LLC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 1401 S BERETANIA ST SUITE 310
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City | HONOLULU
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State | HI
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Zip | 96814-1870
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Country | US
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Telephone | 808-524-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 S BERETANIA ST SUITE 310
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City | HONOLULU
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State | HI
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Zip | 96814-1870
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Country | US
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Telephone | 808-524-4055
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYDEEN M FUJIMOTO-BUSSE
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Credential | MD
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Telephone | 808-524-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 15081
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 6492
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License Number State | HI
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