Provider Demographics
NPI:1134330491
Name:NISHIHARA, MARK DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:NISHIHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4713
Mailing Address - Country:US
Mailing Address - Phone:808-488-0990
Mailing Address - Fax:808-486-4696
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:SUITE 500
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-488-0990
Practice Address - Fax:808-486-4696
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2013-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD15074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine