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General NPI Number Information
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NPI Number | 1457785602
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Entity Type | Organization
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Legal Business Name | JON W. NAKAMURA, M.D., INC.
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 4374 KUKUI GROVE ST SUITE # 102
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City | LIHUE
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State | HI
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Zip | 96766-2007
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Country | US
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Telephone | 808-246-6253
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Fax | 808-245-7215
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Provider Business Mailing Address
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Address Line | 4374 KUKUI GROVE ST SUITE # 102
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City | LIHUE
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State | HI
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Zip | 96766-2007
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Country | US
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Telephone | 808-246-6253
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Fax | 808-245-7215
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON NAKAMURA
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Credential | M.D.
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Telephone | 808-246-6253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MD-6950
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License Number State | HI
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