Provider Demographics
NPI:1427254192
Name:OKAMURA, CHARLES MINORU (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MINORU
Last Name:OKAMURA
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 1:670 PONAHAWAI ST STE 208
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7830
Mailing Address - Country:US
Mailing Address - Phone:808-935-2112
Mailing Address - Fax:
Practice Address - Street 1:670 PONAHAWAI ST STE 208
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7830
Practice Address - Country:US
Practice Address - Phone:808-935-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI21499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5DD7FNW891Medicare PIN