Provider Demographics
NPI:1558324988
Name:HARADA, THEODORE I (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:I
Last Name:HARADA
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 1:1380 LUSITANA STREET
Mailing Address - Street 2:SUITE 804
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-524-3020
Mailing Address - Fax:808-524-8163
Practice Address - Street 1:1380 LUSITANA STREET
Practice Address - Street 2:SUITE 804
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-524-3020
Practice Address - Fax:808-524-8163
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine