Provider Demographics
NPI:1023746195
Name:RICHARDSON, DANIEL AUSTIN
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:AUSTIN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 KOBASHIGAWA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-4151
Mailing Address - Country:US
Mailing Address - Phone:786-266-0907
Mailing Address - Fax:
Practice Address - Street 1:45 GARDNER DRIVE
Practice Address - Street 2:
Practice Address - City:JOINT BASE PEARL HARBOR-HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:808-204-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider