Healthcare Provider Details

I. General information

NPI: 1174521900
Provider Name (Legal Business Name): TERRY K SHIMAMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 605
HONOLULU HI
96817-2364
US

IV. Provider business mailing address

321 N KUAKINI ST STE 810
HONOLULU HI
96817-2364
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-5886
  • Fax: 808-538-6595
Mailing address:
  • Phone: 808-523-5885
  • Fax: 808-538-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11425
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: