Provider Demographics
NPI:1760590988
Name:KOKAME, GREGG T
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:T
Last Name:KOKAME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA ROAD
Mailing Address - Street 2:#470
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4723
Mailing Address - Country:US
Mailing Address - Phone:808-487-8928
Mailing Address - Fax:808-487-3699
Practice Address - Street 1:98-1079 MOANALUA ROAD
Practice Address - Street 2:#470
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4723
Practice Address - Country:US
Practice Address - Phone:808-487-8928
Practice Address - Fax:808-487-3699
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4780207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03202003Medicaid
C98819Medicare UPIN
HIH51785Medicare PIN