Healthcare Provider Details

I. General information

NPI: 1417452236
Provider Name (Legal Business Name): DANE TADASHI KUROHARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KEOKEA PL
KULA HI
96790-7450
US

IV. Provider business mailing address

100 KEOKEA PL
KULA HI
96790-7450
US

V. Phone/Fax

Practice location:
  • Phone: 808-876-4331
  • Fax: 877-564-2599
Mailing address:
  • Phone: 808-876-4331
  • Fax: 877-564-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-21842
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR-7516
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: