Provider Demographics
NPI:1659552925
Name:FUKUDA, RAINE GAY (MD)
Entity Type:Individual
Prefix:MS
First Name:RAINE
Middle Name:GAY
Last Name:FUKUDA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-521-8288
Mailing Address - Fax:808-526-0069
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 1103
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-521-8288
Practice Address - Fax:808-526-0069
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI15080208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBY427ZMedicare UPIN