Basic Information
| Provider Information | |||||||||
| NPI: | 1700985850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORENAGA | ||||||||
| FirstName: | GILBERT | ||||||||
| MiddleName: | MASAYAKI | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4348 WAIALAE AVE | ||||||||
| Address2: | SUITE S-509 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968165767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088475385 | ||||||||
| FaxNumber: | 8083732408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
| Address2: | QUEEN'S MEDICAL CENTER | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085389011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 08/23/2010 | ||||||||
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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 | 207L00000X | 05318 | HI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | E020346 | 01 | HI | HMSA | OTHER | 01895201 | 05 | HI | MEDICAID | 15565770 | 01 | HI | WCOWCP | OTHER |