Provider Demographics
NPI:1982759833
Name:HATAKEYAMA, DEANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANE
Middle Name:
Last Name:HATAKEYAMA
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 1:41-1347 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1247
Mailing Address - Country:US
Mailing Address - Phone:808-259-7948
Mailing Address - Fax:808-259-6449
Practice Address - Street 1:41-1347 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1247
Practice Address - Country:US
Practice Address - Phone:808-259-7948
Practice Address - Fax:808-259-6449
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04958701Medicaid
HI0000228100Medicaid
HIG73185OtherUGS
HI0000212407OtherBLUES
HI99-0273205OtherHMA
HI99-0273205OtherHMAA
HI99-0273205OtherHMA
HIA0000228100Medicare ID - Type UnspecifiedALOHACARE ADVANTAGE
HI0000228100Medicaid