Healthcare Provider Details

I. General information

NPI: 1841364254
Provider Name (Legal Business Name): MICHAEL MAKOTO KUSAKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 S BERETANIA ST
HONOLULU HI
96813-2501
US

IV. Provider business mailing address

839 S BERETANIA ST
HONOLULU HI
96813-2501
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4441
  • Fax: 808-522-2483
Mailing address:
  • Phone: 808-522-4441
  • Fax: 808-522-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number6570
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: