Healthcare Provider Details

I. General information

NPI: 1952485146
Provider Name (Legal Business Name): KEN NAGAMORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST SUITE 1030
HONOLULU HI
96826-1077
US

IV. Provider business mailing address

1319 PUNAHOU ST SUITE 1030
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-7772
  • Fax: 808-955-0789
Mailing address:
  • Phone: 808-955-7772
  • Fax: 808-955-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5279
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number5279
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: