Provider Demographics
NPI:1497853519
Name:DEAN K OTAKA MD INC
Entity Type:Organization
Organization Name:DEAN K OTAKA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-486-5556
Mailing Address - Street 1:MAIL CODE 61153 P.O.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:808-486-5556
Mailing Address - Fax:808-486-5586
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 115
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5300
Practice Address - Country:US
Practice Address - Phone:808-486-5556
Practice Address - Fax:808-486-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102001Medicare PIN
HIG96770Medicare UPIN