Provider Demographics
NPI:1932209475
Name:KANESHIRO, SUZANNE PEGGY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:PEGGY
Last Name:KANESHIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-599-3520
Mailing Address - Fax:808-599-3524
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 1110
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-599-3520
Practice Address - Fax:808-599-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11538207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50677701Medicaid
HIH53626Medicare ID - Type Unspecified
H43531Medicare UPIN