Basic Information
| Provider Information | |||||||||
| NPI: | 1811943236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIRAOKA | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 677 ALA MOANA BLVD | ||||||||
| Address2: | SUITE 1025 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085355975 | ||||||||
| FaxNumber: | 8085355976 | ||||||||
| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST, 8TH FLOOR | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082036588 | ||||||||
| FaxNumber: | 8089511637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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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 | MD11316 | HI | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | HI | MEDICAID |