Provider Demographics
NPI:1104219179
Name:KUNISHIGE, ROYLIN M JR
Entity Type:Individual
Prefix:
First Name:ROYLIN
Middle Name:M
Last Name:KUNISHIGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 OMAO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1963
Mailing Address - Country:US
Mailing Address - Phone:808-960-6417
Mailing Address - Fax:
Practice Address - Street 1:79 OMAO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1963
Practice Address - Country:US
Practice Address - Phone:808-498-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH00624956172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver