Healthcare Provider Details

I. General information

NPI: 1033182613
Provider Name (Legal Business Name): MARK T. KANEMORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LILIHA ST SUITE 105
HONOLULU HI
96817-3169
US

IV. Provider business mailing address

347 N KUAKINI ST
HONOLULU HI
96817-2306
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-3131
  • Fax: 808-524-3189
Mailing address:
  • Phone: 808-547-9548
  • Fax: 808-547-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number9435
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: