Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | MD 13701 | HI |
NPI | 1477663284 |
---|---|
Provider Name | Jon Fukumoto |
First Address | Honolulu, HI 96813-2435 |
Second Address | Honolulu, HI 96813-2435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000262758 | HMSA (01) | HI |
586125-01 | (05) | HI |