Provider Demographics
NPI:1003965476
Name:MEDICAL DIAGNOSTIC PARTNERS LLC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-585-7293
Mailing Address - Street 1:1834 NUUANU AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2427
Mailing Address - Country:US
Mailing Address - Phone:808-585-7293
Mailing Address - Fax:808-585-7292
Practice Address - Street 1:1712 LILIHA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5410
Practice Address - Country:US
Practice Address - Phone:808-531-2200
Practice Address - Fax:808-531-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI579253Medicaid
HI243733OtherHMSA
HI579253Medicaid