Provider Demographics
NPI:1265585491
Name:KIMURA, RICHARD YUTAKA (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:YUTAKA
Last Name:KIMURA
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
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-599-4456
Mailing Address - Fax:808-599-4457
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-599-4456
Practice Address - Fax:808-599-4457
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2348207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03662901Medicaid
HI03662901Medicaid
HIC99813Medicare UPIN