Healthcare Provider Details

I. General information

NPI: 1598834780
Provider Name (Legal Business Name): TODD T. KUBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46-056 KAMEHAMEHA HWY SUITE G-1
KANEOHE HI
96744-3755
US

IV. Provider business mailing address

956 WAIIKI ST
HONOLULU HI
96821-1233
US

V. Phone/Fax

Practice location:
  • Phone: 808-233-6200
  • Fax: 808-233-6255
Mailing address:
  • Phone: 808-285-2448
  • Fax: 808-373-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-7930
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: