Provider Demographics
NPI:1942261862
Name:TERADA, KEITH P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:P
Last Name:TERADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:#803
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-526-2477
Mailing Address - Fax:808-528-3671
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:#803
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-526-2477
Practice Address - Fax:808-528-3671
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI5857207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02444101Medicaid
B49341Medicare UPIN
HI02444101Medicaid