Healthcare Provider Details

I. General information

NPI: 1437577517
Provider Name (Legal Business Name): MYLES MITSUNAGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3100
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

1356 LUSITANA ST STE 510
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-2108
  • Fax:
Mailing address:
  • Phone: 808-586-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number036167369
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA140178
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number19098
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036167369
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number304413-01
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036167369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: