Provider Demographics
NPI:1205880804
Name:KUBO, NEAL MAMORU (OD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:MAMORU
Last Name:KUBO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1002 KAHANUI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4963
Mailing Address - Country:US
Mailing Address - Phone:808-677-2333
Mailing Address - Fax:808-677-2313
Practice Address - Street 1:94-300 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2648
Practice Address - Country:US
Practice Address - Phone:808-677-2333
Practice Address - Fax:808-677-2313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04489001Medicaid
HI62979Medicare UPIN
HI04489001Medicaid