Healthcare Provider Details

I. General information

NPI: 1467815076
Provider Name (Legal Business Name): RICKY KANESHIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 LUSITANA ST STE 510
HONOLULU HI
96813-2409
US

IV. Provider business mailing address

1356 LUSITANA ST STE 510
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-2890
  • Fax:
Mailing address:
  • Phone: 808-586-2890
  • 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 Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD61158437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: