Provider Demographics
NPI:1124363981
Name:SUSAN S. HIRAOKA, DPM, LLC
Entity Type:Organization
Organization Name:SUSAN S. HIRAOKA, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HIRAOKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-261-9931
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-261-9931
Mailing Address - Fax:808-262-9986
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:SUITE 207
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4400
Practice Address - Country:US
Practice Address - Phone:808-261-9931
Practice Address - Fax:808-262-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-155335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI501074Medicaid
HI23066-4OtherHMSA
HI464973OtherOHANA HEALTH
HI464973OtherOHANA HEALTH
HI501074Medicaid