Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 18986 | HI |
Y | 111NI0900X | Internist | 18986 | HI |
N | 208D00000X | General Practice Physician | 18986 | HI |
NPI | 1043637267 |
---|---|
Provider Name | Brandon Osamu Takase |
First Address | Honolulu, HI 96813-2423 |
Second Address | Honolulu, HI 96813-2423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 11/06/2019 |