Healthcare Provider Details

I. General information

NPI: 1275633034
Provider Name (Legal Business Name): CHRISTINE FUKUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859
US

IV. Provider business mailing address

380 HALAKI ST
HONOLULU HI
96821-2102
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-6014
  • Fax: 808-433-5746
Mailing address:
  • Phone: 808-728-4189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-3974
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number3974
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: