Provider Demographics
NPI:1083644975
Name:MORITA, MICHON (MD)
Entity Type:Individual
Prefix:
First Name:MICHON
Middle Name:
Last Name:MORITA
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 1:1380 LUSITANA ST
Mailing Address - Street 2:#712
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2421
Mailing Address - Country:US
Mailing Address - Phone:808-529-0508
Mailing Address - Fax:808-529-0538
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:#712
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-529-0508
Practice Address - Fax:808-529-0538
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9539207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07903402Medicaid
G17028Medicare UPIN
HIH56696Medicare PIN
HI07903402Medicaid