MEDICARE: PACIFIC HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	10685476	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	98333	OTHER	HI	KAISER PROVIDER #
2	0000243493	OTHER	HI	HMSA PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093712762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HEALTH INC

Provider Business Mailing Address
First Line	:	2875 KOAPAKA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-1921
Country	:	US
Telephone Number	:	808-833-3414
Fax Number	:	808-833-3416

Provider Business Practice Location Address
First Line	:	2875 KOAPAKA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-1921
Country	:	US
Telephone Number	:	808-833-3414
Fax Number	:	808-833-3416

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DARYLE ANN HO
Credential	:
Telephone Number	:	808-833-3414

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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Directions to “PACIFIC HEALTH INC ” Practice Location

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