Basic Information
| Provider Information | |||||||||
| NPI: | 1144630732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAKESHI KISHIDA, MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O.BOX 61011 | ||||||||
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| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968392395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087359093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085389011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | KISHIDA | ||||||||
| AuthorizedOfficialFirstName: | TAKESHI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8085365094 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD-2362 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | MD-2362 | 01 | HI | STATE LICENSE | OTHER |