Provider Demographics
NPI:1639365687
Name:OKINO, BLAINE MITSUYUKI (MD)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:MITSUYUKI
Last Name:OKINO
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 1:920 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2008
Mailing Address - Country:US
Mailing Address - Phone:808-322-4400
Mailing Address - Fax:
Practice Address - Street 1:920 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-2008
Practice Address - Country:US
Practice Address - Phone:808-322-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD15229207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57.011806OtherTRAINING CERTIFICATE