Provider Demographics
NPI:1003839069
Name:PACIFIC MAXILLOFACIAL CENTER, LLC
Entity Type:Organization
Organization Name:PACIFIC MAXILLOFACIAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARUKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:808-585-8455
Mailing Address - Street 1:1060 YOUNG ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1609
Mailing Address - Country:US
Mailing Address - Phone:808-585-8455
Mailing Address - Fax:808-585-8458
Practice Address - Street 1:1060 YOUNG ST
Practice Address - Street 2:SUITE 312
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1609
Practice Address - Country:US
Practice Address - Phone:808-585-8455
Practice Address - Fax:808-585-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherINSURANCE PIN