Provider Demographics
NPI:1326024852
Name:SHIMODA, NEAL T (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:T
Last Name:SHIMODA
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 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2390
Mailing Address - Country:US
Mailing Address - Phone:808-521-9584
Mailing Address - Fax:
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 503
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-521-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8663207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03563901Medicaid
HIF82434Medicare UPIN
HI03563901Medicaid