Provider Demographics
NPI:1568439347
Name:NISHIDA, STEVEN DALE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DALE
Last Name:NISHIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST,
Mailing Address - Street 2:#810
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-524-0066
Mailing Address - Fax:808-524-3396
Practice Address - Street 1:1380 LUSITANA ST,
Practice Address - Street 2:SUITE 810
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-524-0066
Practice Address - Fax:808-524-3396
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-6083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE38396Medicare UPIN
HI0000BDQKQMedicare PIN