Provider Demographics
NPI:1568558583
Name:MITSUNAGA, MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:
Last Name:MITSUNAGA
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 ST
Mailing Address - Street 2:SUITE 905
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-522-9633
Mailing Address - Fax:808-522-5333
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 905
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-522-9633
Practice Address - Fax:808-522-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4413207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01010801Medicaid
HIMD4413OtherSTATE LICENSE NUMBER
HIC97517Medicare UPIN
HIH0000BDQKJMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER