Provider Demographics
NPI:1881090405
Name:KAM DIAGNOSTIC RADIOLOGY LLC
Entity type:Organization
Organization Name:KAM DIAGNOSTIC RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-418-0333
Mailing Address - Street 1:95-1009 HELEPU ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6607
Mailing Address - Country:US
Mailing Address - Phone:805-418-0333
Mailing Address - Fax:
Practice Address - Street 1:94-239 WAIPAHU DEPOT ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3056
Practice Address - Country:US
Practice Address - Phone:808-671-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty