Healthcare Provider Details

I. General information

NPI: 1245218577
Provider Name (Legal Business Name): JOHN NAGAMINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST SUITE 304
KAILUA HI
96734-4498
US

IV. Provider business mailing address

642 ULUKAHIKI ST SUITE 304
KAILUA HI
96734-4498
US

V. Phone/Fax

Practice location:
  • Phone: 808-262-5060
  • Fax:
Mailing address:
  • Phone: 808-262-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11430
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: