=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831154905
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALVIN K IKEDA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 02/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 347 N KUAKINI ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-522-0190
-----------------------------------------------------
Fax | 808-523-9068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 N KUAKINI ST SUITE 405
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-2364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-522-0190
-----------------------------------------------------
Fax | 808-523-9068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MD9450
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------