Provider Demographics
NPI:1033182613
Name:KANEMORI, MARK T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:KANEMORI
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 1:347 N KUAKINI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2306
Mailing Address - Country:US
Mailing Address - Phone:808-547-9548
Mailing Address - Fax:808-547-9718
Practice Address - Street 1:1650 LILIHA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3169
Practice Address - Country:US
Practice Address - Phone:808-524-3131
Practice Address - Fax:808-524-3189
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI94352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07808808Medicaid
HIG206644OtherHMSA
HIG29494Medicare UPIN
HIG206644OtherHMSA