Provider Demographics
NPI:1598834780
Name:KUBO, TODD T (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:T
Last Name:KUBO
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 1:956 WAIIKI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1233
Mailing Address - Country:US
Mailing Address - Phone:808-285-2448
Mailing Address - Fax:808-373-3310
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE G-1
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-233-6200
Practice Address - Fax:808-233-6255
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI073325Medicaid
HI00T0095285OtherHMSA
HI073325Medicaid
HI00T0095285OtherHMSA