Provider Demographics
NPI:1770136087
Name:KTAMURA MD INC
Entity type:Organization
Organization Name:KTAMURA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-1473
Mailing Address - Street 1:85 MAUI LANI PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2416
Mailing Address - Country:US
Mailing Address - Phone:808-442-5700
Mailing Address - Fax:808-442-5701
Practice Address - Street 1:85 MAUI LANI PARKWAY
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2416
Practice Address - Country:US
Practice Address - Phone:530-241-1473
Practice Address - Fax:808-442-5701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KTAMURA MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty