Healthcare Provider Details

I. General information

NPI: 1609219112
Provider Name (Legal Business Name): EMI OTA M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 KALAKAUA AVE STE 407
HONOLULU HI
96815-2546
US

IV. Provider business mailing address

2250 KALAKAUA AVE STE 407
HONOLULU HI
96815-2546
US

V. Phone/Fax

Practice location:
  • Phone: 808-367-0513
  • Fax: 808-367-0514
Mailing address:
  • Phone: 808-367-0513
  • Fax: 808-367-0514

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 StateHI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR-6474
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18532
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: