Provider Demographics
NPI:1992243182
Name:STATE OF HAWAII, DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:STATE OF HAWAII, DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTRY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CTR
Authorized Official - Phone:808-586-9750
Mailing Address - Street 1:701 ILALO ST
Mailing Address - Street 2:UH CANCER CENTER, HAWAII TUMOR REGISTRY
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5516
Mailing Address - Country:US
Mailing Address - Phone:808-586-9750
Mailing Address - Fax:
Practice Address - Street 1:701 ILALO ST
Practice Address - Street 2:UH CANCER CENTER, HAWAII TUMOR REGISTRY
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5516
Practice Address - Country:US
Practice Address - Phone:808-586-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI99999999251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare