Provider Demographics
NPI:1730143884
Name:HARADA, RUSSELL N (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:N
Last Name:HARADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4522
Mailing Address - Country:US
Mailing Address - Phone:808-941-3363
Mailing Address - Fax:808-949-0483
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:SUITE 620
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-486-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI075294Medicaid
HIG05354Medicare UPIN
HIH0000BDXRSMedicare ID - Type Unspecified
HI075294Medicaid