Provider Demographics
NPI:1912170473
Name:PACIFIC IMAGING SERVICES
Entity Type:Organization
Organization Name:PACIFIC IMAGING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-282-8603
Mailing Address - Street 1:94-210 PUPUKAHI ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2649
Mailing Address - Country:US
Mailing Address - Phone:808-330-3025
Mailing Address - Fax:808-838-7414
Practice Address - Street 1:94-210 PUPUKAHI ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2649
Practice Address - Country:US
Practice Address - Phone:808-330-3025
Practice Address - Fax:808-838-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA167592471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000260372OtherHMSA
HI582206OtherDSS
HIH101113Medicare PIN