Healthcare Provider Details

I. General information

NPI: 1245525864
Provider Name (Legal Business Name): JORDAN DAZZ RIKIO ARAKAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-17521
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: