Healthcare Provider Details

I. General information

NPI: 1336413913
Provider Name (Legal Business Name): MORRIS MITSUNAGA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST STE 905
HONOLULU HI
96813-2448
US

IV. Provider business mailing address

1380 LUSITANA ST STE 905
HONOLULU HI
96813-2448
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-9633
  • Fax: 808-522-9646
Mailing address:
  • Phone: 808-522-9633
  • Fax: 808-522-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD4413
License Number StateHI

VIII. Authorized Official

Name: DR. MORRIS M MITSUNAGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-522-9633