Healthcare Provider Details

I. General information

NPI: 1598863839
Provider Name (Legal Business Name): GARY KIMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 801
HONOLULU HI
96826-1032
US

IV. Provider business mailing address

PO BOX 25668
HONOLULU HI
96825-0668
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-6580
  • Fax: 808-951-1637
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3800
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: