Provider Demographics
NPI:1316004740
Name:CHAN-IKEDA, RAQUEL JENN LEUN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:JENN LEUN
Last Name:CHAN-IKEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 UALAKAA ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2091
Mailing Address - Country:US
Mailing Address - Phone:808-645-7643
Mailing Address - Fax:
Practice Address - Street 1:1944 UALAKAA ST UNIT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2091
Practice Address - Country:US
Practice Address - Phone:808-645-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 9598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics