Provider Demographics
NPI:1043502792
Name:PACIFIC ASC LLC
Entity type:Organization
Organization Name:PACIFIC ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TONOKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-949-2208
Mailing Address - Street 1:1946 YOUNG ST
Mailing Address - Street 2:SUITE 288
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2169
Mailing Address - Country:US
Mailing Address - Phone:808-949-2208
Mailing Address - Fax:808-949-2209
Practice Address - Street 1:650 IWILEI RD
Practice Address - Street 2:SPACE #225
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5086
Practice Address - Country:US
Practice Address - Phone:808-949-2208
Practice Address - Fax:808-949-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical