Provider Demographics
NPI:1073586772
Name:KOSUT, SHEPHARD SPOONER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEPHARD
Middle Name:SPOONER
Last Name:KOSUT
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 1:227 KAHAKO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5905
Mailing Address - Country:US
Mailing Address - Phone:808-888-2849
Mailing Address - Fax:
Practice Address - Street 1:1481 S KING ST STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2692
Practice Address - Country:US
Practice Address - Phone:808-792-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI152692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00461673Medicare PIN
VA015503C19Medicare PIN