Provider Demographics
NPI:1013038025
Name:RAYMOND K. ITAGAKI, M.D., INC.
Entity Type:Organization
Organization Name:RAYMOND K. ITAGAKI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ITAGAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-531-5448
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-531-5448
Mailing Address - Fax:808-523-5418
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 609
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-531-5448
Practice Address - Fax:808-523-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3847207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04517601Medicaid
HIA51381OtherHMSA PROVIDER NUMBER
HIH0000BDRSCMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
HIC98471Medicare UPIN