Healthcare Provider Details

I. General information

NPI: 1245441583
Provider Name (Legal Business Name): SCOTT TAKEO KAWAMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST SUITE 514
HONOLULU HI
96813-2414
US

IV. Provider business mailing address

98-640 PUAILIMA ST
AIEA HI
96701-2231
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-2911
  • Fax:
Mailing address:
  • Phone: 808-457-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD-14357
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-14357
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: