Healthcare Provider Details

I. General information

NPI: 1366810780
Provider Name (Legal Business Name): JUDY T. OKIMURA, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 404
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 404
HONOLULU HI
96813-2449
US

V. Phone/Fax

Practice location:
  • Phone: 808-690-9888
  • Fax: 808-690-9821
Mailing address:
  • Phone: 808-690-9888
  • Fax: 808-690-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12151
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12151
License Number StateHI

VIII. Authorized Official

Name: DR. JUDY T OKIMURA
Title or Position: OWNER
Credential: MD
Phone: 808-951-0433