Provider Demographics
NPI:1033158464
Name:SAKUDA, KEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:SAKUDA
Suffix:
Gender:M
Credentials:DPM
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 29089
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-1489
Mailing Address - Country:US
Mailing Address - Phone:808-690-4727
Mailing Address - Fax:808-777-1016
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:4081
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2405
Practice Address - Country:US
Practice Address - Phone:808-690-4727
Practice Address - Fax:808-777-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO12402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI005906Medicaid
HI00F005394OtherHMSA/BCBS PROVIDER NUMBER
HI005906Medicaid
HIH0000SCBFTMedicare PIN