Healthcare Provider Details

I. General information

NPI: 1780579334
Provider Name (Legal Business Name): SHUN NAKAHARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 LUSITANA STREET 7TH FLOOR
HONOLULU HI
96813
US

IV. Provider business mailing address

1356 LUSITANA STREET, 7TH FLOOR
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-2910
  • Fax:
Mailing address:
  • Phone: 808-691-4970
  • Fax: 877-290-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMDR-8958
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: