Healthcare Provider Details

I. General information

NPI: 1053708115
Provider Name (Legal Business Name): CASEY SHIMOKAWA R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 PAA ST
HONOLULU HI
96819-4430
US

IV. Provider business mailing address

4134 KEANU ST 2
HONOLULU HI
96816-5517
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1103222
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: