Healthcare Provider Details

I. General information

NPI: 1790084408
Provider Name (Legal Business Name): JAMI FUKUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 S BERETANIA ST
HONOLULU HI
96826-1301
US

IV. Provider business mailing address

701 ILALO ST
HONOLULU HI
96813-5516
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-3444
  • Fax: 808-949-7808
Mailing address:
  • Phone: 808-586-5854
  • Fax: 808-586-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number267618
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number19314
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: