Healthcare Provider Details

I. General information

NPI: 1538165188
Provider Name (Legal Business Name): MARI K OTSUKA I M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 811
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

321 N KUAKINI ST STE 811
HONOLULU HI
96817-2362
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-2731
  • Fax: 808-521-2136
Mailing address:
  • Phone: 808-531-2731
  • Fax: 808-521-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD4561
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: