Provider Demographics
NPI:1245348747
Name:NAKAMOTO, STUART S (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:S
Last Name:NAKAMOTO
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 1:321 N KUAKINI ST STE 805
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2362
Mailing Address - Country:US
Mailing Address - Phone:808-536-1312
Mailing Address - Fax:808-536-1201
Practice Address - Street 1:321 N KUAKINI ST STE 805
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2362
Practice Address - Country:US
Practice Address - Phone:808-536-1312
Practice Address - Fax:808-536-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07899001Medicaid
HI07899001Medicaid
HIG34618Medicare UPIN