Provider Demographics
NPI:1801167119
Name:HIGA, BRANDON T (DPT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:T
Last Name:HIGA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 LOWREY AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1634
Mailing Address - Country:US
Mailing Address - Phone:808-277-1769
Mailing Address - Fax:
Practice Address - Street 1:2659 LOWREY AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1634
Practice Address - Country:US
Practice Address - Phone:808-277-1769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH53533/ CLINICMedicare PIN