Provider Demographics
NPI:1215059704
Name:NAKAMURA, JON NAKAMURA (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:NAKAMURA
Last Name:NAKAMURA
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 1:4374 KUKUI GROVE ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2007
Mailing Address - Country:US
Mailing Address - Phone:808-246-6253
Mailing Address - Fax:808-245-7215
Practice Address - Street 1:4374 KUKUI GROVE ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2007
Practice Address - Country:US
Practice Address - Phone:808-246-6253
Practice Address - Fax:808-245-7215
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD69502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF59153OtherKAISER PIN
HI07258801Medicaid
HI00009OtherHMAA PIN
HI00K094421OtherHMSA PIN
HI99033012096766A002OtherTRICARE PIN
HIF59153OtherKAISER PIN
HIF59153Medicare UPIN