Basic Information
| Provider Information | |||||||||
| NPI: | 1568782605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIKUMA LEE | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | MICHIKO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHIKUMA | ||||||||
| OtherFirstName: | KELSEY | ||||||||
| OtherMiddleName: | MICHIKO | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1356 LUSITANA ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085363773 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1356 LUSITANA ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085363773 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 01/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | A11290 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | A11290 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | MD17573 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | MD17573 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.