Provider Demographics
NPI:1073618377
Name:BRUNO, MICHIKO KIMURA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHIKO
Middle Name:KIMURA
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHIKO
Other - Middle Name:
Other - Last Name:KIMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:STE 705
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-537-9105
Mailing Address - Fax:808-537-9269
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:STE 705
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-537-9105
Practice Address - Fax:808-537-9269
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI127192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI552762-01Medicaid
HIH56806Medicare PIN
HII08207Medicare UPIN