Provider Demographics
NPI:1013262807
Name:MATSUURA, DARI SHIM
Entity Type:Individual
Prefix:MRS
First Name:DARI
Middle Name:SHIM
Last Name:MATSUURA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DARI
Other - Middle Name:HEALANI
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2664 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1706
Mailing Address - Country:US
Mailing Address - Phone:808-988-1781
Mailing Address - Fax:
Practice Address - Street 1:1100 ALAKEA ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2833
Practice Address - Country:US
Practice Address - Phone:808-523-7771
Practice Address - Fax:808-523-1997
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker