Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO-89 | HI |
Y | 222Z00000X | Podiatrist | PO-89 | HI |
NPI | 1053390492 |
---|---|
Provider Name | Ricky T Sukita |
First Address | Honolulu, HI 96817-6301 |
Second Address | Honolulu, HI 96817-6301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 01/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025035 | (05) | HI |
T83237 | (02) | HI |