Healthcare Provider Details

I. General information

NPI: 1376599662
Provider Name (Legal Business Name): LAVONDA NAKAMOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAVONDA MEE-LEE M.D.

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD CFA
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

459 PATTERSON RD CFA
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0224
  • Fax: 808-433-0281
Mailing address:
  • Phone: 808-433-0224
  • Fax: 808-433-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD12941
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number12941
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: