Provider Demographics
NPI:1235164062
Name:HIRAOKA, SUSAN S (DPM LLC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:HIRAOKA
Suffix:
Gender:F
Credentials:DPM LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ULUKAHIKI ST STE 207
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4439
Mailing Address - Country:US
Mailing Address - Phone:808-261-9931
Mailing Address - Fax:
Practice Address - Street 1:642 ULUKAHIKI ST STE 207
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4439
Practice Address - Country:US
Practice Address - Phone:808-261-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-155213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI501074 01Medicaid
HI0230664OtherHMSA
U89612Medicare UPIN
54404Medicare ID - Type Unspecified
HI4615930002Medicare NSC