Provider Demographics
NPI:1528079134
Name:OTAKA, DEAN K (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:K
Last Name:OTAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:MAIL CODE 61153 P.O.BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-486-5556
Mailing Address - Fax:808-486-5586
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:SUITE 115
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5311
Practice Address - Country:US
Practice Address - Phone:808-486-5556
Practice Address - Fax:808-486-5586
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0020533OtherHMSA
HI99-0358001OtherHMA
HI499138OtherQUEST ALOHA CARE
HI49913802Medicaid
HI99-0358001OtherHMAA
HI49913802Medicaid
HIG9670Medicare UPIN