Healthcare Provider Details

I. General information

NPI: 1245977495
Provider Name (Legal Business Name): KALLI MARIE SACHIKO HIRASA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 806
HONOLULU HI
96813-2435
US

IV. Provider business mailing address

1329 LUSITANA ST STE 806
HONOLULU HI
96813-2435
US

V. Phone/Fax

Practice location:
  • Phone: 85-260-0308
  • Fax:
Mailing address:
  • Phone: 808-526-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD-1012
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: