Provider Demographics
NPI:1417091893
Name:OKAHARA, KARA MITSUYO (MD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:MITSUYO
Last Name:OKAHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-935-2112
Mailing Address - Fax:808-935-2110
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 208
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-935-2112
Practice Address - Fax:808-935-2110
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI251591-05Medicaid
HI251591-05Medicaid
HI55687Medicare ID - Type Unspecified