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Individual

DEREK I MITO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
599 FARRINGTON HWY STE 201, KAPOLEI, HI 96707-2028
(808) 674-9500
Mailing address
599 FARRINGTON HWY STE 201, KAPOLEI, HI 96707-2028
(808) 674-9500

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9932
NV
207Q00000X
Family Medicine Physician
Primary
MD-20577
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002016769
NV
01
11041229
CAQH
01
80173665
RAILROAD MEDICARE
NV
Enumeration date
02/14/2006
Last updated
08/04/2020
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