MEDICARE: RICHARD T IKEHARA MD INC

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	207V00000X	Obstetrics & Gynecology Physician	MD8872	HI

General Provider Information

NPI Number	:	1477736189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD T IKEHARA MD INC

Provider Business Mailing Address
First Line	:	MAILCODE 47866 BOX 1300
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96807-1300
Country	:	US
Telephone Number	:	808-941-3363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2065 S KING ST
Second Line	:	SUITE 202
City	:	HONOLULU
State	:	HI
Zip	:	96826-2225
Country	:	US
Telephone Number	:	808-945-8686
Fax Number	:	808-949-6452

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD T IKEHARA
Credential	:	M.D.
Telephone Number	:	808-945-8686

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	04/22/2008

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