Healthcare Provider Details

I. General information

NPI: 1912078031
Provider Name (Legal Business Name): ALVIN SHIRAISHI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST STE 704
HONOLULU HI
96814-1956
US

IV. Provider business mailing address

937A 18TH AVE
HONOLULU HI
96816-4114
US

V. Phone/Fax

Practice location:
  • Phone: 808-593-4436
  • Fax:
Mailing address:
  • Phone: 808-735-2718
  • Fax: 808-735-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMAT 1821
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: