Provider Demographics
NPI:1134553597
Name:RANDALL J. NITTA, MD, LLC
Entity type:Organization
Organization Name:RANDALL J. NITTA, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JIRO
Authorized Official - Last Name:NITTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-260-4404
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 306
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5301
Mailing Address - Country:US
Mailing Address - Phone:808-260-4404
Mailing Address - Fax:808-484-2864
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 306
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5301
Practice Address - Country:US
Practice Address - Phone:808-484-2904
Practice Address - Fax:808-484-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty