Healthcare Provider Details

I. General information

NPI: 1962765826
Provider Name (Legal Business Name): RYAN OTSUKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 811
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

321 N KUAKINI ST STE 811
HONOLULU HI
96817-2362
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number19224
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: