Provider Demographics
NPI:1871577536
Name:PACIFIC RADIOLOGY GROUP INC
Entity type:Organization
Organization Name:PACIFIC RADIOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-522-0190
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:#405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-522-0190
Mailing Address - Fax:808-523-9068
Practice Address - Street 1:347 KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2306
Practice Address - Country:US
Practice Address - Phone:808-522-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3593174400000X
HIMD3504174400000X
HIMD6106174400000X
HIMD7570174400000X
HIMD7714174400000X
HIMD11118174400000X
HIMD9450174400000X
HIMD9646174400000X
HIMD11388174400000X
HIMD11796174400000X
HIMD12846174400000X
HIMD147632085R0202X
HIMD158532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP2650OtherMEDICARE 'B' RAILROAD
HII02518Medicare UPIN
HIH53455Medicare UPIN
HIE55239Medicare UPIN
HIE55241Medicare UPIN
HIG30211Medicare UPIN
HIDT134ZMedicare PIN
HIF14564Medicare UPIN
HIF32485Medicare UPIN
CP2650OtherMEDICARE 'B' RAILROAD
HIG68199Medicare UPIN
HIG10571Medicare UPIN
HIAM027ZMedicare PIN
HIA48682Medicare UPIN
HIG64983Medicare UPIN
H0000WCCBHMedicare PIN