Provider Demographics
NPI:1184710816
Name:KAGAWA, JOAN SETSUKO RUGGIERI (MD)
Entity type:Individual
Prefix:MISS
First Name:JOAN
Middle Name:SETSUKO RUGGIERI
Last Name:KAGAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 WAIALAE AVENUE
Mailing Address - Street 2:A106
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-735-0007
Mailing Address - Fax:808-735-0021
Practice Address - Street 1:4218 WAIALAE AVENUE
Practice Address - Street 2:A106
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-735-0007
Practice Address - Fax:808-735-0021
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD113442084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00D0227902OtherHMSA NONPARTICIPATING
HI53734201Medicaid