Provider Demographics
NPI:1962683052
Name:ISLAND UROLOGY HONOLULU LLC
Entity Type:Organization
Organization Name:ISLAND UROLOGY HONOLULU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYNN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HATA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-522-5055
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-522-5055
Mailing Address - Fax:808-522-5333
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 602
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-522-5055
Practice Address - Fax:808-522-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty