Healthcare Provider Details

I. General information

NPI: 1992016802
Provider Name (Legal Business Name): JILL M.Y.N.W. INOUYE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 300
AIEA HI
96701-4722
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 300
AIEA HI
96701-4722
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-4120
  • Fax: 808-485-3090
Mailing address:
  • Phone: 808-485-4120
  • Fax: 808-485-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD-17030
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: