Provider Demographics
NPI:1073596250
Name:OKAMOTO, JAMES KEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEN
Last Name:OKAMOTO
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 1:94-849 LUMIAINA ST
Mailing Address - Street 2:WAIKELE PROFESSIONAL CTR, SUITE 207
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5025
Mailing Address - Country:US
Mailing Address - Phone:808-677-8222
Mailing Address - Fax:808-677-8333
Practice Address - Street 1:94-849 LUMIAINA ST
Practice Address - Street 2:WAIKELE PROFESSIONAL CTR, SUITE 207
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5025
Practice Address - Country:US
Practice Address - Phone:808-677-8222
Practice Address - Fax:808-677-8333
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032858207Q00000X
HIMD15243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOK6337OtherBLUE SHIELD
WA080088748OtherMEDICARE RAILROAD
WA8181885Medicaid
WA104484OtherLABOR & INDUSTRIES
G15891Medicare UPIN
WAG217120502Medicare PIN