Healthcare Provider Details

I. General information

NPI: 1942409040
Provider Name (Legal Business Name): OKAHARA & OLSEN M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI ST SUITE 208
HILO HI
96720-2660
US

IV. Provider business mailing address

670 PONAHAWAI ST SUITE 208
HILO HI
96720-2660
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-2112
  • Fax: 808-935-2110
Mailing address:
  • Phone: 808-935-2112
  • Fax: 808-935-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10628
License Number StateHI

VIII. Authorized Official

Name: DR. KARA MITSUYO OKAHARA
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 808-935-2112