Provider Demographics
NPI:1629015276
Name:KUNIMURA, JARREN (ABO-AC, NCLC, ABOM)
Entity Type:Individual
Prefix:MR
First Name:JARREN
Middle Name:
Last Name:KUNIMURA
Suffix:
Gender:M
Credentials:ABO-AC, NCLC, ABOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 KOKO HEAD AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3710
Mailing Address - Country:US
Mailing Address - Phone:808-735-7773
Mailing Address - Fax:808-735-7773
Practice Address - Street 1:1142 KOKO HEAD AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3710
Practice Address - Country:US
Practice Address - Phone:808-735-7773
Practice Address - Fax:808-735-7773
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-184156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI6431-1OtherHMSA
HI499295Medicaid
HI499295Medicaid