Healthcare Provider Details

I. General information

NPI: 1497817084
Provider Name (Legal Business Name): DAVID Y NAKAMURA M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI STREET SUITE 216 HILO FAMILY MEDICINE
HILO HI
96720-2660
US

IV. Provider business mailing address

670 PONAHAWAI STREET SUITE 216 HILO FAMILY MEDICINE
HILO HI
96720-2660
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-8989
  • Fax: 808-934-8990
Mailing address:
  • Phone: 808-934-8989
  • Fax: 808-934-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID Y NAKAMURA
Title or Position: PRESIDENT
Credential: MD
Phone: 808-934-8989