Provider Demographics
NPI:1467884536
Name:ALOHA DERMATOLOGY AND LASER CENTER LLC
Entity Type:Organization
Organization Name:ALOHA DERMATOLOGY AND LASER CENTER LLC
Other - Org Name:MICKI LY, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:N
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-877-6526
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:PUUNENE
Mailing Address - State:HI
Mailing Address - Zip Code:96784-0668
Mailing Address - Country:US
Mailing Address - Phone:808-877-6526
Mailing Address - Fax:808-877-7033
Practice Address - Street 1:89 HOOKELE ST
Practice Address - Street 2:101
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3532
Practice Address - Country:US
Practice Address - Phone:808-877-6526
Practice Address - Fax:808-877-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty