Basic Information
| Provider Information | |||||||||
| NPI: | 1679656557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUROZAWA | ||||||||
| FirstName: | DARYL | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-184 HUALALAI RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75-184 HUALALAI RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD-8674 | HI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 038477-02 | 05 | HI | MEDICAID |