Provider Demographics
NPI:1912480237
Name:ISLAND FAMILY SURGICAL CARE CENTER LLC
Entity Type:Organization
Organization Name:ISLAND FAMILY SURGICAL CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:088-682-2778
Mailing Address - Street 1:411 HUKU LII PL STE 304
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-868-2277
Mailing Address - Fax:808-439-6060
Practice Address - Street 1:411 HUKU LII PL STE 304
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7062
Practice Address - Country:US
Practice Address - Phone:808-868-2277
Practice Address - Fax:808-439-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty