MEDICARE: DR. NATHAN KOJI ITOGA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	0	CA

General Provider Information

NPI Number	:	1366880098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN KOJI ITOGA M.D.

Provider Business Mailing Address
First Line	:	1508 LAUKAHI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-1432
Country	:	US
Telephone Number	:	808-295-0319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 LAUKAHI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-1432
Country	:	US
Telephone Number	:	808-295-0319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	06/04/2013

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