Healthcare Provider Details

I. General information

NPI: 1447519293
Provider Name (Legal Business Name): JOEY Y. KOHATSU, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 303
HONOLULU HI
96813-2411
US

IV. Provider business mailing address

1329 LUSITANA ST STE 303
HONOLULU HI
96813-2411
US

V. Phone/Fax

Practice location:
  • Phone: 808-807-0311
  • Fax: 808-807-0322
Mailing address:
  • Phone: 808-807-0311
  • Fax: 808-807-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15549
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number15549
License Number StateHI

VIII. Authorized Official

Name: JOEY YOSHIO KOHATSU
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 808-807-0311