Organization
PACIFIC TRAINING PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA ICHINOTSUBO (BOARD MEMBER)
(808) 488-6846
Entity
Organization
Contact information
Practice address
99-128 AIEA HEIGHTS DR, SUITE 108, AIEA, HI 96701-3925
(808) 488-6846
Mailing address
99-128 AIEA HEIGHTS DR, SUITE 108, AIEA, HI 96701-3925
(808) 488-6846
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD-11341
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51484202
—
HI
Enumeration date
08/24/2006
Last updated
08/22/2020
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