Provider Demographics
NPI:1922399617
Name:GARETH K. NAKASONE, MD INC.
Entity type:Organization
Organization Name:GARETH K. NAKASONE, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARETH
Authorized Official - Middle Name:KEONI
Authorized Official - Last Name:NAKASONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-595-3698
Mailing Address - Street 1:PO BOX 17569
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-0569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3028 HOLUA WAY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2932
Practice Address - Country:US
Practice Address - Phone:808-847-5385
Practice Address - Fax:808-847-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 15319207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty