Provider Demographics
NPI:1356454433
Name:OKIMURA, JUDY TAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:TAE
Last Name:OKIMURA
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 1:1380 LUSITANA ST STE 404
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2440
Mailing Address - Country:US
Mailing Address - Phone:808-951-0433
Mailing Address - Fax:808-690-9821
Practice Address - Street 1:1380 LUSITANA ST STE 404
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2440
Practice Address - Country:US
Practice Address - Phone:808-951-2433
Practice Address - Fax:808-690-9821
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12151207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54061801Medicaid
HI54061801Medicaid
HI55862Medicare ID - Type Unspecified