Provider Demographics
NPI:1952458135
Name:HAWAII PACIFIC ONCOLOGY CENTER
Entity Type:Organization
Organization Name:HAWAII PACIFIC ONCOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-933-0625
Mailing Address - Street 1:1285 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1227
Mailing Address - Country:US
Mailing Address - Phone:808-933-0625
Mailing Address - Fax:808-974-6864
Practice Address - Street 1:1285 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1227
Practice Address - Country:US
Practice Address - Phone:808-933-0625
Practice Address - Fax:808-974-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50115701Medicaid
HIG59121Medicare UPIN
HI57598Medicare ID - Type Unspecified