1215059704 NPI number — DR. JON NAKAMURA NAKAMURA M.D.

Table of content: DR. JON NAKAMURA NAKAMURA M.D. (NPI 1215059704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215059704 NPI number — DR. JON NAKAMURA NAKAMURA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAKAMURA
Provider First Name:
JON
Provider Middle Name:
NAKAMURA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215059704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4374 KUKUI GROVE ST
Provider Second Line Business Mailing Address:
SUITE # 102
Provider Business Mailing Address City Name:
LIHUE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96766-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-246-6253
Provider Business Mailing Address Fax Number:
808-245-7215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4374 KUKUI GROVE ST
Provider Second Line Business Practice Location Address:
SUITE # 102
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-246-6253
Provider Business Practice Location Address Fax Number:
808-245-7215
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD6950 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F59153 . This is a "KAISER PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 07258801 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00009 . This is a "HMAA PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00K094421 . This is a "HMSA PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99033012096766A002 . This is a "TRICARE PIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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