Healthcare Provider Details

I. General information

NPI: 1568558583
Provider Name (Legal Business Name): MORRIS MITSUNAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 905
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 905
HONOLULU HI
96813-2449
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-9633
  • Fax: 808-522-5333
Mailing address:
  • Phone: 808-522-9633
  • Fax: 808-522-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD4413
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD4413
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: