Healthcare Provider Details

I. General information

NPI: 1629279617
Provider Name (Legal Business Name): MARIKO KATHERINE JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-1000
  • Fax:
Mailing address:
  • Phone: 808-691-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005016358
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD-16098
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: