Provider Demographics
NPI:1962953372
Name:HAWAII PAIN SPECIALISTS LLC
Entity type:Organization
Organization Name:HAWAII PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-676-5541
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-445-9120
Mailing Address - Fax:808-445-9124
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-445-9120
Practice Address - Fax:808-445-9124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII PAIN SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS1366332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies