Provider Demographics
NPI:1528050630
Name:HARA, CHRISTINE SETSUKO (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SETSUKO
Last Name:HARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LILIHA ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3562
Mailing Address - Country:US
Mailing Address - Phone:808-545-3567
Mailing Address - Fax:808-545-3568
Practice Address - Street 1:1520 LILIHA ST
Practice Address - Street 2:SUITE 404
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3562
Practice Address - Country:US
Practice Address - Phone:808-545-3567
Practice Address - Fax:808-545-3568
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4303208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01041601-01Medicaid