Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC-1083 | HI |
NPI | 1205012218 |
---|---|
Provider Name | Dr. Brandon L. Kikuchi |
First Address | Honolulu, HI 96816-1332 |
Second Address | Honolulu, HI 96816-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000274993 | BCBS - HMSA (01) | HI |
556858 | HMA (01) | HI |