Provider Demographics
NPI:1295423119
Name:DISU HAWAII INC
Entity type:Organization
Organization Name:DISU HAWAII INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-282-9676
Mailing Address - Street 1:1319 PUNAHOU ST STE 1070
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1081
Mailing Address - Country:US
Mailing Address - Phone:808-944-8551
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST STE 1070
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1081
Practice Address - Country:US
Practice Address - Phone:808-944-8551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISU HAWAII INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty