Provider Demographics
NPI:1417047226
Name:TAKAI, MASAO (MD)
Entity Type:Individual
Prefix:
First Name:MASAO
Middle Name:
Last Name:TAKAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 128 AIEA HGTS DR
Mailing Address - Street 2:SUITE 705
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-488-1665
Mailing Address - Fax:808-487-0884
Practice Address - Street 1:99 128 AIEA HGTS DR
Practice Address - Street 2:SUITE 705
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-488-1665
Practice Address - Fax:808-487-0884
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2684207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T0039176OtherHMSA
HI03548501Medicaid
T0039176OtherHMSA
HI03548501Medicaid
0333630001Medicare NSC
H0000BDHPJMedicare ID - Type Unspecified