Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DT-2883 | HI |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD-22040 | HI |
NPI | 1386037570 |
---|---|
Provider Name | Dr. Rodney Nakano Nishimoto |
First Address | Honolulu, HI 96826-2500 |
Second Address | Honolulu, HI 96826-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 04/10/2021 |