Healthcare Provider Details

I. General information

NPI: 1356965347
Provider Name (Legal Business Name): KAITLYNN MIYOSHI EBISUTANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD SPC 3010
AIEA HI
96701-4735
US

IV. Provider business mailing address

1319 PUNAHOU ST # 824
HONOLULU HI
96826-1080
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-0090
  • Fax: 908-671-5376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-24152
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: