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General NPI Number Information
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NPI Number | 1134619729
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Entity Type | Individual
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Provider Name | CHAD IMANAKA MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | PSYCHIATRY RESIDENCY PROGRAM 1356 LUSITANA STREET, 4TH FLOOR
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City | HONOLULU
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State | HI
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Zip | 96813-1030
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Country | US
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Telephone | 808-895-7948
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Fax |
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Provider Business Mailing Address
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Address Line | BRAIN HEALTH HAWAII 4211 WAIALAE AVE SUITE 203
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City | HONOLULU
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State | HI
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Zip | 96816-1030
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Country | US
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Telephone | 808-554-5688
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-22393
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDR-7528
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License Number State | HI
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