Healthcare Provider Details

I. General information

NPI: 1194714238
Provider Name (Legal Business Name): CLIFFORD I OKUMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST STE 1603
HONOLULU HI
96814-3116
US

IV. Provider business mailing address

615 PIIKOI ST STE 1603
HONOLULU HI
96814-3116
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-8778
  • Fax: 808-596-8558
Mailing address:
  • Phone: 808-596-8778
  • Fax: 808-596-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM06069
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: