Provider Demographics
NPI:1407192750
Name:OWEN K. NISHIKAWA M.D., LLC
Entity type:Organization
Organization Name:OWEN K. NISHIKAWA M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:KOH
Authorized Official - Last Name:NISHIKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-536-5383
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-536-5383
Mailing Address - Fax:808-526-0877
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-536-5383
Practice Address - Fax:808-526-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053471797OtherINDIVIDUAL NPI NUMBER
HIH56552Medicare PIN
H76830Medicare UPIN