Healthcare Provider Details

I. General information

NPI: 1750511697
Provider Name (Legal Business Name): KENJI SEKIGUCHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 LUSITANA ST 7TH FLOOR
HONOLULU HI
96813-2421
US

IV. Provider business mailing address

1423 LUSITANA ST 7TH FLOOR
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-2910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR-5676
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: