Healthcare Provider Details

I. General information

NPI: 1164608493
Provider Name (Legal Business Name): ABIGAIL S HARADA M D L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 604
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1585 KAPIOLANI BLVD SUITE 1800
HONOLULU HI
96814-4522
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-2020
  • Fax: 808-523-2030
Mailing address:
  • Phone: 808-941-3363
  • Fax: 808-949-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD-14427
License Number StateHI

VIII. Authorized Official

Name: DR. ABIGAIL SUTIMA HARADA
Title or Position: SOLE MEMBER/PHYSICIAN
Credential: M.D.
Phone: 808-523-2020