Healthcare Provider Details

I. General information

NPI: 1093772261
Provider Name (Legal Business Name): MARK TOYOKAZU KUGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 S KING ST SUITE310
HONOLULU HI
96814-2601
US

IV. Provider business mailing address

1481 S KING ST SUITE310
HONOLULU HI
96814-2601
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-2844
  • Fax: 808-944-8472
Mailing address:
  • Phone: 808-947-2844
  • Fax: 808-944-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2480
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: