Provider Demographics
NPI:1831135169
Name:TAKEMOTO- GENTILE, CURTIS
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:
Last Name:TAKEMOTO- GENTILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3243
Mailing Address - Country:US
Mailing Address - Phone:808-955-1544
Mailing Address - Fax:808-955-5474
Practice Address - Street 1:2632 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3243
Practice Address - Country:US
Practice Address - Phone:808-955-1544
Practice Address - Fax:808-955-5474
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04912501Medicaid
HI04912501Medicaid
E50813Medicare UPIN