Provider Demographics
NPI:1598717902
Name:NAGAHIRO, KEN
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:NAGAHIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-803 PAPIPI RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2438
Mailing Address - Country:US
Mailing Address - Phone:808-689-7911
Mailing Address - Fax:808-689-8831
Practice Address - Street 1:91-803 PAPIPI RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2438
Practice Address - Country:US
Practice Address - Phone:808-689-7911
Practice Address - Fax:808-689-8831
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5873-5OtherHMSA
HI5873-5OtherTRICARE
HI5873-5OtherALOHA CARE QUEST
HI0000058735OtherHMSA QUEST
HI05135801Medicaid
HI5873-5OtherHMAA
HI5873-5OtherHMA
HI5873-5OtherSUMMERLIN LIFE AND HEALTH
HI5873-5OtherHMAA
HI0716720001Medicare NSC