Healthcare Provider Details

I. General information

NPI: 1568456713
Provider Name (Legal Business Name): VICTOR KATSUJI INADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/07/2023
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAFAYETTE STREET 6TH FLOOR
NEW YORK NY
10013
US

IV. Provider business mailing address

915 N KING ST
HONOLULU HI
96817-4544
US

V. Phone/Fax

Practice location:
  • Phone: 212-334-6029
  • Fax: 212-334-7956
Mailing address:
  • Phone: 808-848-1438
  • Fax: 808-841-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-19712
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number223668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: