Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 738 | HI |
Y | 213EG0000X | General Practice | 738 | HI |
NPI | 1003856162 |
---|---|
Provider Name | Dr. Richard S. Moritmoto |
First Address | Kailua, HI 96734-2526 |
Second Address | Kailua, HI 96734-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06340301 | (05) | HI |