Provider Demographics
NPI:1942409040
Name:OKAHARA & OLSEN M.D.,INC.
Entity Type:Organization
Organization Name:OKAHARA & OLSEN M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:MITSUYO
Authorized Official - Last Name:OKAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-935-2112
Mailing Address - Street 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-935-2112
Mailing Address - Fax:808-935-2110
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 208
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-935-2112
Practice Address - Fax:808-935-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55685Medicare PIN