Provider Demographics
NPI:1396827473
Name:INOUE, KOURTNEY K (RD)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:K
Last Name:INOUE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:K
Other - Last Name:SATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1449 S BERETANIA ST
Mailing Address - Street 2:STE A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1866
Mailing Address - Country:US
Mailing Address - Phone:808-432-0000
Mailing Address - Fax:
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH55835Medicare PIN
HIP97923Medicare UPIN