Provider Demographics
NPI:1114045838
Name:NAKANO, BRIAN KIYOSHI (DO)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KIYOSHI
Last Name:NAKANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:380 HUKU LII PL
Mailing Address - Street 2:STE. 107
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7043
Mailing Address - Country:US
Mailing Address - Phone:808-879-8544
Mailing Address - Fax:808-874-3899
Practice Address - Street 1:380 HUKU LII PL
Practice Address - Street 2:STE. 107
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7043
Practice Address - Country:US
Practice Address - Phone:808-879-8544
Practice Address - Fax:808-874-3899
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-78156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000009233OtherHMSA