Provider Demographics
NPI:1386743771
Name:HIMEDA, SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HIMEDA
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 1:1100 WARD AVE
Mailing Address - Street 2:700
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1600
Mailing Address - Country:US
Mailing Address - Phone:808-544-2600
Mailing Address - Fax:
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:700
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1600
Practice Address - Country:US
Practice Address - Phone:808-544-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI045165-01Medicaid
HI192966OtherHMN
HI00X005137-0OtherHMSA
HI377541OtherUHA
HI709629OtherFIRST HEALTH
HIMD3810OtherMDX
HI192966OtherHMN
HIH0000BDHDDMedicare PIN
HI110114723Medicare ID - Type UnspecifiedRAILROAD