Provider Demographics
NPI:1508823790
Name:KURATA, LANCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:MICHAEL
Last Name:KURATA
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 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-587-7998
Mailing Address - Fax:808-587-7768
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 901
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-587-7998
Practice Address - Fax:808-587-7768
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 9825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08826301Medicaid
HI51125Medicare ID - Type Unspecified
HI08826301Medicaid