Provider Demographics
NPI:1053390492
Name:SUKITA, RICKY T (DPM)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:T
Last Name:SUKITA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DAIRY RD SUITE D
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2348
Mailing Address - Country:US
Mailing Address - Phone:808-877-3668
Mailing Address - Fax:808-877-3248
Practice Address - Street 1:405 NO. KUAKINI ST.
Practice Address - Street 2:SUITE 1111
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6301
Practice Address - Country:US
Practice Address - Phone:808-596-0305
Practice Address - Fax:808-521-1119
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-89213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI025035Medicaid
HIT83237Medicare UPIN
HI0536550001Medicare NSC
HIH0000SCBCPMedicare PIN