Provider Demographics
NPI:1598863839
Name:KIMOTO, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KIMOTO
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:PO BOX 25668
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0668
Mailing Address - Country:US
Mailing Address - Phone:808-536-0314
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:1319 PUNAHOU ST STE 801
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1032
Practice Address - Country:US
Practice Address - Phone:808-203-6580
Practice Address - Fax:808-951-1637
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04793702Medicaid
HIC98482Medicare UPIN
HIH0000BDHTWMedicare PIN