Provider Demographics
NPI:1164804076
Name:TOTAL DEFENSE SYSTEM LLC
Entity Type:Organization
Organization Name:TOTAL DEFENSE SYSTEM LLC
Other - Org Name:UNITED MMA & FITNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEWELZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-271-2423
Mailing Address - Street 1:94-530 UKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4213
Mailing Address - Country:US
Mailing Address - Phone:808-271-2423
Mailing Address - Fax:
Practice Address - Street 1:94-530 UKEE ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4213
Practice Address - Country:US
Practice Address - Phone:808-271-2423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization