Healthcare Provider Details

I. General information

NPI: 1881203289
Provider Name (Legal Business Name): HAWAII INJURY RECOVERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 09/09/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 501
HONOLULU HI
96817-2387
US

IV. Provider business mailing address

321 N KUAKINI ST STE 501
HONOLULU HI
96817-2387
US

V. Phone/Fax

Practice location:
  • Phone: 808-762-0777
  • Fax: 808-762-0775
Mailing address:
  • Phone: 808-343-3915
  • Fax: 808-762-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT MORIOKA
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 808-343-3915