Provider Demographics
NPI:1396777637
Name:KOSASA, THOMAS SIDNEY (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:SIDNEY
Last Name:KOSASA
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 1:1319 PUNAHOU STREET
Mailing Address - Street 2:SUITE 1040
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1028
Mailing Address - Country:US
Mailing Address - Phone:808-949-2304
Mailing Address - Fax:808-951-7004
Practice Address - Street 1:1319 PUNAHOU STREET
Practice Address - Street 2:SUITE 1040
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1028
Practice Address - Country:US
Practice Address - Phone:808-949-2304
Practice Address - Fax:808-951-7004
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2581207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000BDHBPMedicare PIN
C98818Medicare UPIN