Provider Demographics
NPI:1477667350
Name:USHIJIMA, CHARLENE M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:M
Last Name:USHIJIMA
Suffix:
Gender:F
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:PO BOX 25668
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0668
Mailing Address - Country:US
Mailing Address - Phone:808-536-0300
Mailing Address - Fax:
Practice Address - Street 1:1380 LUSITANA ST STE 1014
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2461
Practice Address - Country:US
Practice Address - Phone:808-536-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08809801Medicaid
H51082Medicare ID - Type Unspecified
G69859Medicare UPIN