Provider Demographics
NPI:1386714962
Name:HAWAII DIAGNOSTIC RADIOLOGY SERVICES LLC
Entity type:Organization
Organization Name:HAWAII DIAGNOSTIC RADIOLOGY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KC
Authorized Official - Last Name:YEOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-949-0091
Mailing Address - Street 1:1481 S KING ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2506
Mailing Address - Country:US
Mailing Address - Phone:808-949-0091
Mailing Address - Fax:808-957-0005
Practice Address - Street 1:1481 S KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2506
Practice Address - Country:US
Practice Address - Phone:808-949-0091
Practice Address - Fax:808-957-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHYEOHM002Medicare ID - Type Unspecified
HIHYEOHMMedicare ID - Type Unspecified