Provider Demographics
NPI:1033565981
Name:HAWAII CANCER CARE INC
Entity type:Organization
Organization Name:HAWAII CANCER CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:FUKUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-524-6115
Mailing Address - Street 1:500 ALA MOANA BLVD STE 6230
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4929
Mailing Address - Country:US
Mailing Address - Phone:808-524-6115
Mailing Address - Fax:808-528-1711
Practice Address - Street 1:500 ALA MOANA BLVD STE 6230
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4929
Practice Address - Country:US
Practice Address - Phone:808-524-6115
Practice Address - Fax:808-528-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty