Healthcare Provider Details

I. General information

NPI: 1235119850
Provider Name (Legal Business Name): JOEL R OKAZAKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912141 FORT WEAVER RD
EWA BEACH HI
96706
US

IV. Provider business mailing address

941 KAMEHAMEHA HWY STE 208
PEARL CITY HI
96782-2516
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-7037
  • Fax: 808-678-7039
Mailing address:
  • Phone: 808-454-5200
  • Fax: 808-454-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD5551
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: