Provider Demographics
NPI:1720188501
Name:GINOZA, KIM E T (OD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:E T
Last Name:GINOZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:E
Other - Last Name:TAKAMORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2531
Mailing Address - Country:US
Mailing Address - Phone:808-243-6000
Mailing Address - Fax:
Practice Address - Street 1:80 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2531
Practice Address - Country:US
Practice Address - Phone:808-243-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000241604OtherHMSA BILLING NUMBER
HI537152-01Medicaid
HIU95746Medicare UPIN
HI537152-01Medicaid