Provider Demographics
NPI:1194714238
Name:OKUMOTO, CLIFFORD I (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:I
Last Name:OKUMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:STE 1603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-596-8778
Mailing Address - Fax:808-596-8558
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:STE 1603
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-596-8778
Practice Address - Fax:808-596-8558
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIM060692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02426501Medicaid
HIA27043OtherHMSA
E85410Medicare UPIN
HI02426501Medicaid