Provider Demographics
NPI:1154641371
Name:USS PASADENA(SSN752)
Entity Type:Organization
Organization Name:USS PASADENA(SSN752)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ELL
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-382-1143
Mailing Address - Street 1:888 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818
Mailing Address - Country:US
Mailing Address - Phone:858-382-1143
Mailing Address - Fax:
Practice Address - Street 1:888 MURRAY DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3721
Practice Address - Country:US
Practice Address - Phone:858-382-1143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty