Healthcare Provider Details

I. General information

NPI: 1053390492
Provider Name (Legal Business Name): RICKY T SUKITA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NO. KUAKINI ST. SUITE 1111
HONOLULU HI
96817-6301
US

IV. Provider business mailing address

415 DAIRY RD SUITE D
KAHULUI HI
96732-2348
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-0305
  • Fax: 808-521-1119
Mailing address:
  • Phone: 808-877-3668
  • Fax: 808-877-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-89
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: