Provider Demographics
NPI:1316039860
Name:TAKASHIMA, WILLIAM S (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:TAKASHIMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MAMALA BAY DR BLDG 3417
Mailing Address - Street 2:
Mailing Address - City:JB PEARL HARBOR HICKAM
Mailing Address - State:HI
Mailing Address - Zip Code:96853-1801
Mailing Address - Country:US
Mailing Address - Phone:808-789-0184
Mailing Address - Fax:
Practice Address - Street 1:360 MAMALA BAY DR BLDG 3417
Practice Address - Street 2:
Practice Address - City:JB PEARL HARBOR HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96853-1801
Practice Address - Country:US
Practice Address - Phone:808-789-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI039742-01Medicaid
HI00N0043561OtherHMSA BILLING NUMBER
HI039742-01Medicaid
HIH52007Medicare PIN