Healthcare Provider Details

I. General information

NPI: 1033158464
Provider Name (Legal Business Name): KEN SAKUDA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST 4081
HONOLULU HI
96813-2405
US

IV. Provider business mailing address

PO BOX 29089
HONOLULU HI
96820-1489
US

V. Phone/Fax

Practice location:
  • Phone: 808-690-4727
  • Fax: 808-777-1016
Mailing address:
  • Phone: 808-690-4727
  • Fax: 808-777-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO12402
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: