Provider Demographics
NPI:1114979762
Name:KUNIMOTO, ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:KUNIMOTO
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 1:1126 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1919
Mailing Address - Country:US
Mailing Address - Phone:808-593-8935
Mailing Address - Fax:808-596-9104
Practice Address - Street 1:1126 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1919
Practice Address - Country:US
Practice Address - Phone:808-593-8935
Practice Address - Fax:808-596-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1533174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03150301Medicaid
HI00B003491-4OtherHAWAII MEDICAL SERVICE AS
HIC98820Medicare UPIN
HIH0000BDBLXMedicare ID - Type UnspecifiedMEDICARE