Healthcare Provider Details

I. General information

NPI: 1386854545
Provider Name (Legal Business Name): REID HAMAMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-885 KUHIO HWY # A1
KAPAA HI
96746-2702
US

IV. Provider business mailing address

4-831 KUHIO HWY STE 438 PMB 331
KAPAA HI
96746-1578
US

V. Phone/Fax

Practice location:
  • Phone: 888-594-0049
  • Fax: 888-592-2998
Mailing address:
  • Phone: 888-594-0049
  • Fax: 888-592-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14097
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14097
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: