Provider Demographics
NPI: | 1033565981 |
---|---|
Name: | HAWAII CANCER CARE INC |
Entity Type: | Organization |
Organization Name: | HAWAII CANCER CARE INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FUKUMOTO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 808-524-6115 |
Mailing Address - Street 1: | 500 ALA MOANA BLVD STE 6230 |
Mailing Address - Street 2: | |
Mailing Address - City: | HONOLULU |
Mailing Address - State: | HI |
Mailing Address - Zip Code: | 96813-4929 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 808-524-6115 |
Mailing Address - Fax: | 808-528-1711 |
Practice Address - Street 1: | 500 ALA MOANA BLVD STE 6230 |
Practice Address - Street 2: | |
Practice Address - City: | HONOLULU |
Practice Address - State: | HI |
Practice Address - Zip Code: | 96813-4929 |
Practice Address - Country: | US |
Practice Address - Phone: | 808-524-6115 |
Practice Address - Fax: | 808-528-1711 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-05-10 |
Last Update Date: | 2021-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
HI | 3621 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty |