Provider Demographics
NPI:1366493645
Name:PACIFIC ORTHOPAEDICS AND SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:PACIFIC ORTHOPAEDICS AND SPORTS MEDICINE INC
Other - Org Name:STEVEN A. KANESHIRO, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANESHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-531-0663
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2360
Mailing Address - Country:US
Mailing Address - Phone:808-531-0663
Mailing Address - Fax:808-534-1551
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 309
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-531-0663
Practice Address - Fax:808-534-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07818701Medicaid
HI0206805OtherHMSA
HIG30842Medicare UPIN
HI07818701Medicaid