Healthcare Provider Details

I. General information

NPI: 1730308917
Provider Name (Legal Business Name): ROBIN RUSSELL INABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

770 KAPIOLANI BLVD #705
HONOLULU HI
96813-5212
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-4311
  • Fax:
Mailing address:
  • Phone: 808-597-8791
  • Fax: 808-597-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD14302
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301084366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: