Provider Demographics
NPI:1720474265
Name:NAKATA, JENA Y (DO)
Entity Type:Individual
Prefix:DR
First Name:JENA
Middle Name:Y
Last Name:NAKATA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 KAILUA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2841
Mailing Address - Country:US
Mailing Address - Phone:808-263-9100
Mailing Address - Fax:808-263-9120
Practice Address - Street 1:602 KAILUA RD STE 200
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-263-9100
Practice Address - Fax:808-263-9120
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine