MEDICARE: GARETH K. NAKASONE, 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	207L00000X	Anesthesiology Physician	MD - 15319	HI

General Provider Information

NPI Number	:	1922399617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARETH K. NAKASONE, MD INC.

Provider Business Mailing Address
First Line	:	PO BOX 17569
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-0569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3028 HOLUA WAY
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-2932
Country	:	US
Telephone Number	:	808-847-5385
Fax Number	:	808-847-5387

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARETH KEONI NAKASONE
Credential	:	MD
Telephone Number	:	808-595-3698

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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