Basic Information
| Provider Information | |||||||||
| NPI: | 1548209760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURAYAMA | ||||||||
| FirstName: | KENRIC | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1356 LUSITANA STREET, 6TH FLOOR | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968133714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085868225 | ||||||||
| FaxNumber: | 2155863022 | ||||||||
| Practice Location | |||||||||
| Address1: | 1329 LUSITANA ST STE 207 | ||||||||
| Address2: | QUEEN'S POB II | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084398423 | ||||||||
| FaxNumber: | 8085283671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 12/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD12309 | HI | Y | Other Service Providers | Specialist | 208600000X | MD434663 | PA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 102165530 | 05 | PA | MEDICAID |