Provider Demographics
NPI:1467419630
Name:KADOOKA, CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:KADOOKA
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 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-935-6635
Mailing Address - Fax:808-933-3055
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-935-6635
Practice Address - Fax:808-933-3055
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD4066OtherMEDICAL LICENSE
HI0000BDQNCMedicare ID - Type Unspecified
HIC97448Medicare UPIN