Healthcare Provider Details

I. General information

NPI: 1114042868
Provider Name (Legal Business Name): MARK A MORISAKI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 620
AIEA HI
96701-4716
US

IV. Provider business mailing address

PO BOX 25370
HONOLULU HI
96825-0370
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-2224
  • Fax:
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number11904
License Number StateHI

VIII. Authorized Official

Name: MARK A MORISAKI
Title or Position: OWNER
Credential: MD
Phone: 808-488-2224