Provider Demographics
NPI:1265713028
Name:NISHIDA, KORI K (AUD)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:K
Last Name:NISHIDA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:
Other - Last Name:NITTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:888 S KING ST
Mailing Address - Street 2:STRODE BUILDING, 2ND FLOOR, ENT
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3097
Mailing Address - Country:US
Mailing Address - Phone:808-522-4530
Mailing Address - Fax:
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:STRODE BUILDING, 2ND FLOOR, ENT
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3097
Practice Address - Country:US
Practice Address - Phone:808-522-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD132231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist