Provider Demographics
NPI:1669560306
Name:NAKAMURA, TRAVIS HIDEKI (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:HIDEKI
Last Name:NAKAMURA
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 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE #1011
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-596-7791
Mailing Address - Fax:808-440-2255
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE #1011
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-596-7791
Practice Address - Fax:808-440-2255
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57568101Medicaid
I42398Medicare UPIN
HI57568101Medicaid