Provider Demographics
NPI:1780120709
Name:HAWAII DERMATOPATHOLOGY LLC
Entity type:Organization
Organization Name:HAWAII DERMATOPATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KERSTEN
Authorized Official - Last Name:REISENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-264-2293
Mailing Address - Street 1:1300 N HOLOPONO ST STE 214
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6945
Mailing Address - Country:US
Mailing Address - Phone:808-874-3444
Mailing Address - Fax:
Practice Address - Street 1:1300 N HOLOPONO ST STE 214
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6945
Practice Address - Country:US
Practice Address - Phone:808-874-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12D2120536291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI12D2120536OtherCLIA