Healthcare Provider Details

I. General information

NPI: 1568439347
Provider Name (Legal Business Name): STEVEN DALE NISHIDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST, SUITE 810
HONOLULU HI
96813
US

IV. Provider business mailing address

1380 LUSITANA ST, #810
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-0066
  • Fax: 808-524-3396
Mailing address:
  • Phone: 808-524-0066
  • Fax: 808-524-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-6083
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: