Healthcare Provider Details

I. General information

NPI: 1295034866
Provider Name (Legal Business Name): NICHOLAS KEN MURAOKA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 04/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N KUAKINI ST
HONOLULU HI
96817-2488
US

IV. Provider business mailing address

226 N KUAKINI ST
HONOLULU HI
96817-2488
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-3511
  • Fax: 808-544-3335
Mailing address:
  • Phone: 808-531-3511
  • Fax: 808-544-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A13327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDOS 1685
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDOS 1685
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: