Active NPI
Ted J. Watanabe, M.D.
- Diagnostic Radiology Physician
- Honolulu, HI
National Provider Identifier
1720042658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- MD3504
- Practice address
- 347 N Kuakini St
Honolulu, HI 96817-2306 - Phone
- (808) 522-0190
- Fax
- (808) 523-9068
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD3504 | HI | Primary |
Addresses
Primary practice location
347 N Kuakini St
Honolulu, HI 96817-2306
Mailing address
321 N Kuakini St
Suite 405
Honolulu, HI 96817-2364
Phone (808) 522-0190
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001215403 | Medicaid | HI | |
| 0012773 | Other | HI | QUEST HMSA |
| 300017130 | Other | HI | PALMETTO GBA |
| J012771 | Other | HI | QUEST HMSA |
| 0012773 | Other | HI | HMSA |
| 0012773 | Other | HI | BLUE CROSS/BLUE SHIELD |
| 00J0012771 | Other | HI | QUEST HMSA |
| 99015769896701B006 | Other | HI | WEST REGION CLAIMS (WPS) |
| 0001215402 | Medicaid | HI | |
| 012154-02 | Other | HI | ST DEPT OF PUB SAFETY |
| 990157698002 | Other | HI | HAWAII ELECTRICIANS |
| MD3504 | Other | HI | QUEST-QUEENS HAWAII CARE |
| 012154-03 | Other | HI | ST DEPT OF PUB SAFETY |
| 20124380 | Other | HI | US DEPT OF LABOR |
| 990157698-96817-E006 | Other | HI | TRICARE |
| 1082145098 | Other | HI | AETNA |
| J012771 | Other | HI | HMSA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD3504 | HI | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486425600000",
"number": "1720042658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 N KUAKINI ST",
"address_2": "SUITE 405",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968172364",
"telephone_number": "808-522-0190",
"fax_number": "808-523-9068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "347 N KUAKINI ST",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968172306",
"telephone_number": "808-522-0190",
"fax_number": "808-523-9068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATANABE",
"first_name": "TED",
"middle_name": "J.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2017-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "HI",
"license": "MD3504",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0001215403",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUEST HMSA",
"identifier": "0012773",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "300017130",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUEST HMSA",
"identifier": "J012771",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA",
"identifier": "0012773",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "0012773",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUEST HMSA",
"identifier": "00J0012771",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WEST REGION CLAIMS (WPS)",
"identifier": "99015769896701B006",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0001215402",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ST DEPT OF PUB SAFETY",
"identifier": "012154-02",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAWAII ELECTRICIANS",
"identifier": "990157698002",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUEST-QUEENS HAWAII CARE",
"identifier": "MD3504",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ST DEPT OF PUB SAFETY",
"identifier": "012154-03",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "20124380",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "990157698-96817-E006",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1082145098",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA",
"identifier": "J012771",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.