Provider Demographics
NPI:1619167335
Name:NAKAGAWA, KOHHEI
Entity Type:Individual
Prefix:
First Name:KOHHEI
Middle Name:
Last Name:NAKAGAWA
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:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0863
Mailing Address - Country:US
Mailing Address - Phone:907-412-0945
Mailing Address - Fax:412-802-7249
Practice Address - Street 1:2240 KUHIO AVE APT 2114
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2814
Practice Address - Country:US
Practice Address - Phone:907-519-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190003207Q00000X
AK6119207Q00000X
HIMD22975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19IPMedicaid
AKHS19OPMedicaid
AKHS19OPMedicaid
AKHS19IPMedicaid