NPIMap

Organization Active NPI

Pacific Nephrology LLC

  • Specialist
  • Wailuku, HI
National Provider Identifier
1932379971
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD12546 Issued in HI
Legal business name
PACIFIC NEPHROLOGY LLC
Practice address
95 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone
(808) 244-1444
Fax
(808) 244-1445
NPI assigned
Mar 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Jay Ian Lakkis, M.D.NPI 1447325782
Title
Owner
Phone
(808) 244-1444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD12546 HI Primary

Addresses

Primary practice location

95 Maui Lani Pkwy
Wailuku, HI 96793-2416

Mailing address

95 Maui Lani Pkwy
Wailuku, HI 96793-2416
Phone (808) 244-1444

Other practice location 1

105 Mauilani Pkwy
Ste.100
Wailuku, HI 96793-2442
Phone (808) 244-9555

Other identifiers 1

IdentifierTypeStateIssuer
54015501MedicaidHI

National Provider Directory

National Provider Directory
Tax ID family
Pacific Nephrology LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1932379971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-244-1444",
            "fax_number": "808-244-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-244-1444",
            "fax_number": "808-244-1445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Mauilani Pkwy",
            "address_2": "Ste.100",
            "address_purpose": "LOCATION",
            "city": "Wailuku",
            "state": "HI",
            "postal_code": "967932442",
            "country_code": "US",
            "telephone_number": "808-244-9555",
            "fax_number": "808-244-9577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PACIFIC NEPHROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-05",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "LAKKIS",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-244-1444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "HI",
            "license": "MD12546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54015501",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wailuku, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.