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General NPI Number Information
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NPI Number | 1083003172
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Entity Type | Individual
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Provider Name | MR. KENTARO HANAWA
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Gender | Male
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 94-294 ANANIA DR
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City | MILILANI
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State | HI
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Zip | 96789-2525
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Country | US
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Telephone | 308-627-1593
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 ENOS LN APT A
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City | HONOLULU
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State | HI
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Zip | 96822-4514
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Country | US
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Telephone | 308-627-1593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | AT-303
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License Number State | HI
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