Provider Demographics
NPI:1417912205
Name:ONO, BENJAMIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:M
Last Name:ONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1248 KINOOLE ST
Mailing Address - Street 2:STE 103
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4171
Mailing Address - Country:US
Mailing Address - Phone:808-935-7137
Mailing Address - Fax:808-934-0006
Practice Address - Street 1:1248 KINOOLE ST
Practice Address - Street 2:STE 103
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-7137
Practice Address - Fax:808-934-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54171OtherHMSA
HI04764001Medicaid
HI04764001Medicaid
HIH0000BDHQRMedicare ID - Type Unspecified