Healthcare Provider Details

I. General information

NPI: 1518009240
Provider Name (Legal Business Name): GARY S INAMINE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 SOUTH KING ST SUITE 101
HONOLULU HI
96826
US

IV. Provider business mailing address

1660 SOUTH KING ST SUITE #101
HONOLULU HI
96826
US

V. Phone/Fax

Practice location:
  • Phone: 808-942-5565
  • Fax: 808-942-5573
Mailing address:
  • Phone: 808-942-5565
  • Fax: 808-942-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD3797
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15400
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number3797
License Number StateHI

VIII. Authorized Official

Name: DR. GARY S. INAMINE
Title or Position: PRESIDENT
Credential: MD
Phone: 808-942-5565