Healthcare Provider Details

I. General information

NPI: 1407045883
Provider Name (Legal Business Name): JAMES T. KAKUDA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD SUITE #580
AIEA HI
96701-4713
US

IV. Provider business mailing address

98-1079 MOANALUA RD SUITE #580
AIEA HI
96701-4713
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-7797
  • Fax: 808-487-2764
Mailing address:
  • Phone: 808-488-7797
  • Fax: 808-487-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number12417
License Number StateHI

VIII. Authorized Official

Name: DR. JAMES TAI KAKUDA
Title or Position: MANAGER
Credential: M.D.
Phone: 808-488-7797