Provider Demographics
NPI:1467517185
Name:FREDERICK A. HARADA, M.D. LLC
Entity Type:Organization
Organization Name:FREDERICK A. HARADA, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-585-7771
Mailing Address - Street 1:MAILCODE 47866 BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-941-3363
Mailing Address - Fax:808-949-0483
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 909
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-585-7771
Practice Address - Fax:808-585-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11974261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI10693824OtherHAWAII WITHHOLDING ID
HI=========OtherFEIN
HIH55183Medicare ID - Type Unspecified
HIH63814Medicare UPIN
HIH55184Medicare PIN