Provider Demographics
NPI:1154689271
Name:INAMASU, KEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:S
Last Name:INAMASU
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 1:98-1374 AKAAKA ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3047
Mailing Address - Country:US
Mailing Address - Phone:808-224-6355
Mailing Address - Fax:
Practice Address - Street 1:770 KAPIOLANI BLVD STE 705
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5241
Practice Address - Country:US
Practice Address - Phone:808-597-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18943207P00000X
HI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty