MEDICARE: COR IMAGING, 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	1223X0008X	Oral and Maxillofacial Radiology Dentistry	DT-2029	HI

General Provider Information

NPI Number	:	1770713414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COR IMAGING, INC.

Provider Business Mailing Address
First Line	:	1441 KAPIOLANI BLVD
Second Line	:	SUITE 911
City	:	HONOLULU
State	:	HI
Zip	:	96814-4402
Country	:	US
Telephone Number	:	808-951-5551
Fax Number	:	808-951-5553

Provider Business Practice Location Address
First Line	:	1441 KAPIOLANI BLVD
Second Line	:	SUITE 911
City	:	HONOLULU
State	:	HI
Zip	:	96814-4402
Country	:	US
Telephone Number	:	808-951-5551
Fax Number	:	808-951-5553

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RYAN D LEE
Credential	:	DDS,MS
Telephone Number	:	808-951-5551

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2009

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1952397465 — MR. TIMOTHY WATERS B.SC (PHYSIOTHERAPY)
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1497716591 — DR. ROHINTON J PATEL DMD
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Practice Location Address:

1441 KAPIOLANI BLVD , SUITE 1300
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1174544878 — DR. HAROLD DAN BERTIL NILSSON M.D.
Practice Location Address:

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1780608950 — DR. JASON W KAMEZAWA D.M.D.
Practice Location Address:

1441 KAPIOLANI BLVD , SUITE 1501
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96814-4402

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1881609253 — DR. KENNETH T. YASUHARA D.D.S.
Practice Location Address:

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Directions to “COR IMAGING, INC. ” Practice Location

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