Healthcare Provider Details

I. General information

NPI: 1831171925
Provider Name (Legal Business Name): BYRON HIDEO IZUKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 122
AIEA HI
96701-5300
US

IV. Provider business mailing address

98-1247 KAAHUMANU ST STE 122
AIEA HI
96701-5300
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-8985
  • Fax: 808-485-8986
Mailing address:
  • Phone: 808-485-8985
  • Fax: 808-485-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD10533
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: