Provider Demographics
NPI:1245269430
Name:ISA, JASON MITSUKI (MD, MSPH)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MITSUKI
Last Name:ISA
Suffix:
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-545-1557
Mailing Address - Fax:808-545-5743
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-545-1557
Practice Address - Fax:808-545-5743
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13815207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI582363-01Medicaid
HI582363-01Medicaid
HII67077Medicare UPIN