Basic Information
Provider Information
NPI: 1154417756
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAKUGAWA
FirstName: TERRI
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 86-260 FARRINGTON HWY
Address2:  
City: WAIANAE
State: HI
PostalCode: 967923128
CountryCode: US
TelephoneNumber: 8086967081
FaxNumber: 8086967093
Practice Location
Address1: 86-260 FARRINGTON HWY
Address2:  
City: WAIANAE
State: HI
PostalCode: 967923128
CountryCode: US
TelephoneNumber: 8086967081
FaxNumber: 8086967093
Other Information
ProviderEnumerationDate: 10/04/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XDOS-726HIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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