Provider Demographics
NPI:1497848964
Name:KIMURA, ROGER T (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:T
Last Name:KIMURA
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 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2361
Mailing Address - Country:US
Mailing Address - Phone:808-523-6966
Mailing Address - Fax:808-532-0497
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 508
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2361
Practice Address - Country:US
Practice Address - Phone:808-523-6966
Practice Address - Fax:808-532-0497
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI012418 01Medicaid
HI012418 01Medicaid
C98812Medicare UPIN