Provider Demographics
NPI:1225479892
Name:ORTHOPEDIC SURGERY OF HAWAII CORP
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY OF HAWAII CORP
Other - Org Name:GARY Y OKAMURA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-550-0498
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUTE 501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-550-0498
Mailing Address - Fax:808-522-9646
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 501
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-550-0498
Practice Address - Fax:808-522-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04085301Medicaid
HI04085301Medicaid