Provider Demographics
NPI:1922174044
Name:WYNETTE Y KITAJIMA M.D INC
Entity Type:Organization
Organization Name:WYNETTE Y KITAJIMA M.D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WYNETTE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KITAJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-322-8831
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0010
Mailing Address - Country:US
Mailing Address - Phone:808-322-8831
Mailing Address - Fax:808-322-6443
Practice Address - Street 1:81-990 HALEKII ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8104
Practice Address - Country:US
Practice Address - Phone:808-322-8831
Practice Address - Fax:808-322-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00235001Medicaid
HI00235001Medicaid
HIH102760Medicare PIN