Organization
PACIFIC NEPHROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY IAN LAKKIS M.D. (PHYSICIAN - MEMBER AND MANAGER)
(808) 244-1444
Entity
Organization
Contact information
Practice address
95 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 244-1444
(808) 244-1445
Mailing address
95 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 244-1444
(808) 244-1445
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD-12546
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54015501
—
HI
Enumeration date
11/12/2013
Last updated
03/17/2018
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