MEDICARE: PACIFIC VASCULAR ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363AS0400X	Surgical Physician Assistant
2	363L00000X	Nurse Practitioner
3	363A00000X	Physician Assistant
4	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1154888014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC VASCULAR ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	98-1079 MOANALUA RD STE 620
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-4716
Country	:	US
Telephone Number	:	808-486-7775
Fax Number	:	808-486-5558

Provider Business Practice Location Address
First Line	:	99-115 AIEA HEIGHTS DR STE 246
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3914
Country	:	US
Telephone Number	:	314-973-9571
Fax Number	:	808-486-5558

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KAREN STRONG
Credential	:
Telephone Number	:	314-973-9571

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	03/06/2026

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