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General NPI Number Information
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NPI Number | 1982100962
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Entity Type | Organization
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Legal Business Name | PROPOFOL DREAMS
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 500 ALA MOANA BLVD SUITE SUITE 1B
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 808-227-6477
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Fax | 808-726-2199
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Provider Business Mailing Address
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Address Line | PO BOX 6007
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City | KANEOHE
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State | HI
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Zip | 96744-9167
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Country | US
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Telephone | 808-227-6477
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Fax | 808-726-2199
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Authorized Official
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Title or Position | OWNER
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Name | JASON A TAN
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Credential | M.D.
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Telephone | 808-227-6477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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