Healthcare Provider Details

I. General information

NPI: 1528068343
Provider Name (Legal Business Name): WYNETTE Y KITAJIMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-990 HALEKII ST
KEALAKEKUA HI
96750-8104
US

IV. Provider business mailing address

PO BOX 10
KEALAKEKUA HI
96750-0010
US

V. Phone/Fax

Practice location:
  • Phone: 808-322-8331
  • Fax: 808-322-6443
Mailing address:
  • Phone: 808-322-8831
  • Fax: 808-322-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD-9824
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: