Provider Demographics
NPI:1851396881
Name:SHIBATA, TOSHIYUKI (MD)
Entity Type:Individual
Prefix:DR
First Name:TOSHIYUKI
Middle Name:
Last Name:SHIBATA
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 1:600 KAPIOLANI BLVD
Mailing Address - Street 2:STE 402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5141
Mailing Address - Country:US
Mailing Address - Phone:808-537-2665
Mailing Address - Fax:808-524-3747
Practice Address - Street 1:600 KAPIOLANI BLVD
Practice Address - Street 2:STE 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5141
Practice Address - Country:US
Practice Address - Phone:808-537-2665
Practice Address - Fax:808-524-3747
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD80522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07792301Medicaid
HIB206363OtherHMSA
HIG26124Medicare UPIN
HI07792301Medicaid