Provider Demographics
NPI:1477655116
Name:OGAWA, SHOZO (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOZO
Middle Name:
Last Name:OGAWA
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 1:1441 KAPIOLANI BLVD, #2000
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-945-3719
Mailing Address - Fax:808-945-3629
Practice Address - Street 1:2065 S KING ST STE 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2225
Practice Address - Country:US
Practice Address - Phone:808-941-3766
Practice Address - Fax:808-942-2775
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03148101Medicaid
HI034892OtherBCBS OF HAWAII (HMSA)
HI03148101Medicaid
HIC98878Medicare UPIN