Provider Demographics
NPI:1093134215
Name:OAHU DERMATOLOGY LLC
Entity Type:Organization
Organization Name:OAHU DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-536-9888
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-536-9888
Mailing Address - Fax:808-585-8450
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-536-9888
Practice Address - Fax:808-585-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty