Provider Demographics
NPI:1952485146
Name:NAGAMORI, KEN (MD)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:NAGAMORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-955-7772
Mailing Address - Fax:808-955-0789
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:SUITE 1030
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1077
Practice Address - Country:US
Practice Address - Phone:808-955-7772
Practice Address - Fax:808-955-0789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI52792080A0000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01883101Medicaid
HIA20220OtherHMSA
HIMD5279OtherMDX
HI00188310OtherALOHA CARE
F82437Medicare UPIN