Provider Demographics
NPI:1851279012
Name:KUSAKA, MARC (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:KUSAKA
Suffix:
Gender:M
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 HOOLAULEA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1442
Mailing Address - Country:US
Mailing Address - Phone:808-352-5949
Mailing Address - Fax:
Practice Address - Street 1:2214 HOOLAULEA ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1442
Practice Address - Country:US
Practice Address - Phone:808-352-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133V00000X
HI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered