Pacific Medical Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PACIFIC MEDICAL DERMATOLOGY LLC

Practice address

1888 Kalakaua Ave Ste C104
Honolulu, HI 96815-1555

Phone

(808) 205-7266

NPI assigned

Aug 11, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrick Pan, MDNPI 1700024536

Title

Member

Phone

(808) 205-7266

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yun Sun Lee, MD

  • Dermatology Physician
  • Honolulu, HI
  • NPI 1871805721
  Medicare reassignment NPD
• Patrick E Pan, M.D.

  • Family Medicine Physician
  • Honolulu, HI
  • NPI 1700024536
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1639844681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1888 KALAKAUA AVE STE C104",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968151555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1888 KALAKAUA AVE STE C104",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968151555",
            "telephone_number": "808-205-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MEDICAL DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-11",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A",
        "authorized_official_last_name": "PAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "808-205-7266",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pacific Healthcare Services LLC
• Pacific in Vitro Fertilization Institute
• Pacific Maxillofacial Center, LLC
• Pacific Maxillofacial Center, LLC
• Pacific Medical Associates LLC
• Pacific Medicine, LLP
• Pacific Merdian Partners LLC
• Pacific Mobile Imaging LLC
• Pacific Neurolink
• Pacific Neuropsychology Services

• Dermatology Physician in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Dermatology Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.