Provider Demographics
NPI:1326230194
Name:SHIMABUKURO, KRISTIN KIMIKO (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KIMIKO
Last Name:SHIMABUKURO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MAKALOA ST STE 590
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3216
Mailing Address - Country:US
Mailing Address - Phone:808-947-0111
Mailing Address - Fax:808-955-2523
Practice Address - Street 1:1580 MAKALOA ST STE 590
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3216
Practice Address - Country:US
Practice Address - Phone:808-947-0111
Practice Address - Fax:808-955-2523
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2618152W00000X
HI669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist