Provider Demographics
NPI:1518009240
Name:GARY S INAMINE MD INC
Entity Type:Organization
Organization Name:GARY S INAMINE MD INC
Other - Org Name:GARY S. INAMINE, MD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:INAMINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-942-5565
Mailing Address - Street 1:1660 SOUTH KING ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-942-5565
Mailing Address - Fax:808-942-5573
Practice Address - Street 1:1660 SOUTH KING ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826
Practice Address - Country:US
Practice Address - Phone:808-942-5565
Practice Address - Fax:808-942-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3797207R00000X
HIMD15400207R00000X
HI3797261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC98793Medicare UPIN
HIH0000BDHBTMedicare PIN