Provider Demographics
NPI:1962479360
Name:PAN PACIFIC PATHOLOGISTS, LLC
Entity Type:Organization
Organization Name:PAN PACIFIC PATHOLOGISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-680-7238
Mailing Address - Street 1:33 LANIHULI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4142
Mailing Address - Country:US
Mailing Address - Phone:808-935-4814
Mailing Address - Fax:808-935-2518
Practice Address - Street 1:91-2135 FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1929
Practice Address - Country:US
Practice Address - Phone:808-677-7999
Practice Address - Fax:808-677-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI88CL74207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH50909Medicare PIN
HICJ3998Medicare PIN