Provider Demographics
NPI:1477736189
Name:RICHARD T IKEHARA MD INC
Entity Type:Organization
Organization Name:RICHARD T IKEHARA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:IKEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-945-8686
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:
Practice Address - Street 1:2065 S KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2225
Practice Address - Country:US
Practice Address - Phone:808-945-8686
Practice Address - Fax:808-949-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG50469Medicare UPIN
HIH103267Medicare PIN
HI103268Medicare PIN