Provider Demographics
NPI:1134220221
Name:HAGINO, TIMOTHY H (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:H
Last Name:HAGINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ALA MOANA BLVD APT 407
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4943
Mailing Address - Country:US
Mailing Address - Phone:808-486-4144
Mailing Address - Fax:
Practice Address - Street 1:74-517 HONOKOHAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2715
Practice Address - Country:US
Practice Address - Phone:808-334-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6994174400000X
HIMD-6994207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C0065767OtherHMSA BILLING NUMBER
HI057111-01Medicaid
HIH0000BDQSLMedicare PIN
HI057111-01Medicaid