Healthcare Provider Details

I. General information

NPI: 1033169628
Provider Name (Legal Business Name): AKIO OISO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 KOKU LN GUAM TRAVELERS CLINIC
TAMUNING GU
96913-3977
US

IV. Provider business mailing address

175 KOKU LN GUAM TRAVELERS CLINIC
TAMUNING GU
96913-3977
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-7771
  • Fax: 671-647-7773
Mailing address:
  • Phone: 671-647-7771
  • Fax: 671-647-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-077681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: