Provider Demographics
NPI:1609237783
Name:PACIFIC PERMANENTE MEDICAL GROUP
Entity Type:Organization
Organization Name:PACIFIC PERMANENTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:N
Authorized Official - Last Name:HASEGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-432-5791
Mailing Address - Street 1:2828 PAA ST
Mailing Address - Street 2:SUITE 2050
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4430
Mailing Address - Country:US
Mailing Address - Phone:808-432-5791
Mailing Address - Fax:808-432-5867
Practice Address - Street 1:2828 PAA ST
Practice Address - Street 2:SUITE 2050
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4430
Practice Address - Country:US
Practice Address - Phone:808-432-5791
Practice Address - Fax:808-432-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty