Provider Demographics
NPI:1922108463
Name:SUZANNE P. KANESHIRO, M.D., INC.
Entity Type:Organization
Organization Name:SUZANNE P. KANESHIRO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:PEGGY
Authorized Official - Last Name:KANESHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-599-3520
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-599-3520
Mailing Address - Fax:808-599-3524
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 1110
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-599-3520
Practice Address - Fax:808-599-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11538207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty