MEDICARE: CLIFFORD I OKUMOTO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	M06069	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A27043	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1194714238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFFORD I OKUMOTO MD

Provider Business Mailing Address
First Line	:	615 PIIKOI ST
Second Line	:	STE 1603
City	:	HONOLULU
State	:	HI
Zip	:	96814-3116
Country	:	US
Telephone Number	:	808-596-8778
Fax Number	:	808-596-8558

Provider Business Practice Location Address
First Line	:	615 PIIKOI ST
Second Line	:	STE 1603
City	:	HONOLULU
State	:	HI
Zip	:	96814-3116
Country	:	US
Telephone Number	:	808-596-8778
Fax Number	:	808-596-8558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	12/05/2012

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Directions to “ CLIFFORD I OKUMOTO MD” Practice Location

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