Provider Demographics
NPI:1538165188
Name:OTSUKA, MARI K I (MD)
Entity type:Individual
Prefix:DR
First Name:MARI
Middle Name:K
Last Name:OTSUKA
Suffix:I
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 1:321 N KUAKINI ST
Mailing Address - Street 2:STE 811
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2362
Mailing Address - Country:US
Mailing Address - Phone:808-531-2731
Mailing Address - Fax:808-521-2136
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:STE 811
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2362
Practice Address - Country:US
Practice Address - Phone:808-531-2731
Practice Address - Fax:808-521-2136
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01259401Medicaid
HI0-01330-0OtherHMSA PROVIDER NUMBER
HI110179329OtherRAILROAD MEDICARE NUMBER
HIA01330-8OtherHMSA PROVIDER NUMBER
HIC98886Medicare UPIN
HI0-01330-0OtherHMSA PROVIDER NUMBER