Healthcare Provider Details

I. General information

NPI: 1871902429
Provider Name (Legal Business Name): BRADLEY K TOKESHI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

PO BOX 240130
HONOLULU HI
96824-0130
US

V. Phone/Fax

Practice location:
  • Phone: 808-561-6626
  • Fax:
Mailing address:
  • Phone: 808-561-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD-17610
License Number StateHI

VIII. Authorized Official

Name: DR. BRADLEY KENKOU TOKESHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-561-6626