Provider Demographics
NPI:1356864433
Name:RANDALL H. HIRATA M.D., INC.
Entity Type:Organization
Organization Name:RANDALL H. HIRATA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HIRATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-969-7763
Mailing Address - Street 1:82 PUUHONU PL STE 209
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2010
Mailing Address - Country:US
Mailing Address - Phone:808-969-7763
Mailing Address - Fax:808-935-7821
Practice Address - Street 1:82 PUUHONU PL STE 209
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-969-7763
Practice Address - Fax:808-935-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8027207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07873702Medicaid