=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700078094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AL'S VINYL REPAIR INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2007
-----------------------------------------------------
Last Update Date | 11/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98-1247 KAAHUMANU ST SUITE #117B
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-488-9987
-----------------------------------------------------
Fax | 808-488-0623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3221 WAIALAE AVE STE #345
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-5842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-732-5223
-----------------------------------------------------
Fax | 808-735-9598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. CARLEEN JALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-732-5223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 101
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------