Provider Demographics
NPI:1831154905
Name:IKEDA, ALVIN K (MD)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:K
Last Name:IKEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-522-0190
Mailing Address - Fax:808-523-9068
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2306
Practice Address - Country:US
Practice Address - Phone:808-522-0190
Practice Address - Fax:808-523-9068
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD94502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI108-2145098OtherAETNA
HI990157698-96701-B008OtherTRICARE
HI990157698007OtherHI ELEC
HIMD9450OtherQUEENS HEALTHCARE
HI00B0208021OtherQUEST HMSA
HI103802483OtherUS MARSHALL SVC-FED DET C
HIA208023OtherHMSA
HI07907801Medicaid
HI201243800OtherUS LABOR DEPT
HI300067403OtherPALMETTO GBA
HI90157698OtherAETNA, UHC, CIGNA
HIB208021OtherHMSA
HI00A0208023OtherQUEST HMSA
HI079078-01OtherST DEPT OF PUB SAFETY
HI079078-02OtherST DEPT OF PUB SAFETY
HI07907802Medicaid
HI990157698-96817-E008OtherTRICARE
HI108-2145098OtherAETNA
HI90157698OtherAETNA, UHC, CIGNA