Healthcare Provider Details

I. General information

NPI: 1205012218
Provider Name (Legal Business Name): BRANDON L. KIKUCHI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE STE 307
HONOLULU HI
96816-1332
US

IV. Provider business mailing address

1029 KAPAHULU AVE SUITE 307
HONOLULU HI
96816-1332
US

V. Phone/Fax

Practice location:
  • Phone: 808-781-3139
  • Fax:
Mailing address:
  • Phone: 808-781-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC-1083
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: