Provider Demographics
NPI:1972718013
Name:URGENT CARE CLINIC OF WAIKIKI, LLC
Entity Type:Organization
Organization Name:URGENT CARE CLINIC OF WAIKIKI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASUSHI
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-924-3399
Mailing Address - Street 1:2155 KALAKAUA AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2354
Mailing Address - Country:US
Mailing Address - Phone:808-924-3399
Mailing Address - Fax:808-923-7606
Practice Address - Street 1:2155 KALAKAUA AVE STE 308
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2354
Practice Address - Country:US
Practice Address - Phone:808-924-3399
Practice Address - Fax:808-923-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-10758261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56748Medicare ID - Type Unspecified