Healthcare Provider Details

I. General information

NPI: 1316066905
Provider Name (Legal Business Name): SHANE INOUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

500 ALA MOANA BLVD STE 4-510
HONOLULU HI
96813-4925
US

V. Phone/Fax

Practice location:
  • Phone: 808-748-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-16470
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD-16470
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: