Provider Demographics
NPI:1114005675
Name:KUROSU, CATHERINE JEAN (MD, LAC)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JEAN
Last Name:KUROSU
Suffix:
Gender:F
Credentials:MD, LAC
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:JEAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:417 ULUNIU ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2551
Mailing Address - Country:US
Mailing Address - Phone:808-366-3985
Mailing Address - Fax:808-441-5993
Practice Address - Street 1:417 ULUNIU ST
Practice Address - Street 2:SUITE G
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2551
Practice Address - Country:US
Practice Address - Phone:808-366-3985
Practice Address - Fax:808-441-5993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50972207V00000X
HIMD-15815208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064490Medicaid