Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DIO-78 | HI |
NPI | 1114045838 |
---|---|
Provider Name | Mr. Brian Kiyoshi Nakano |
First Address | Kihei, HI 96753-7043 |
Second Address | Kihei, HI 96753-7043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000009233 | HMSA (01) | HI |