Basic Information
| Provider Information | |||||||||
| NPI: | 1447256094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTSUKA | ||||||||
| FirstName: | CLIVE | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 N KUAKINI ST | ||||||||
| Address2: | STE 811 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085312731 | ||||||||
| FaxNumber: | 8085212136 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 N KUAKINI ST | ||||||||
| Address2: | STE 811 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085312731 | ||||||||
| FaxNumber: | 8085212136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD4659 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A01334-0 | 01 | HI | HMSA / BCBS NUMBER | OTHER | C01334-6 | 01 | HI | HMSA / BCBS NUMBER | OTHER | 110114260 | 01 | HI | RAILROAD MEDICARE NUMBER | OTHER | 01263801 | 05 | HI | MEDICAID |