Provider Demographics
NPI:1629167556
Name:IMOTO, ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:IMOTO
Suffix:
Gender:F
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:PO BOX 283045
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96828-3045
Mailing Address - Country:US
Mailing Address - Phone:808-222-3643
Mailing Address - Fax:
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:STRODE LOWER LEVEL
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:808-522-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7624207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00H0090616OtherHMSA
019847556OtherUHA
HIMD7624-01OtherMDX
HI069739-13Medicaid
HI00H0090616OtherHMSA
019847556OtherUHA