Healthcare Provider Details

I. General information

NPI: 1235164062
Provider Name (Legal Business Name): SUSAN S HIRAOKA DPM LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE 207
KAILUA HI
96734-4439
US

IV. Provider business mailing address

642 ULUKAHIKI ST STE 207
KAILUA HI
96734-4439
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-9931
  • Fax:
Mailing address:
  • Phone: 808-261-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-155
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: